TY - JOUR
T1 - Influence of the Acidic Beverage Cola on the Absorption of Erlotinib in Patients With Non-Small-Cell Lung Cancer
AU - van Leeuwen, Roelof
AU - Peric, Robert
AU - Hussaarts, Koen
AU - Kienhuis, Emma
AU - IJzerman, Nikki
AU - de Bruijn, Peter
AU - Leest, Kornelis
AU - Codrington, H
AU - Kloover, JS
AU - van der Holt, Ronnie
AU - Aerts, Joachim
AU - Gelder, Teun
AU - Mathijssen, Ron
PY - 2016
Y1 - 2016
N2 - Purpose Erlotinib depends on stomach pH for its bioavailability. When erlotinib is taken concurrently with a proton pump inhibitor (PPI), stomach pH increases, which results in a clinically relevant decrease of erlotinib bioavailability. We hypothesized that this drug-drug interaction is reversed by taking erlotinib with the acidic beverage cola. The effects of cola on erlotinib bioavailability in patients not treated with a PPI were also studied. Patients and Methods In this randomized, cross-over, pharmacokinetic study in patients with non-small-cell lung cancer, we studied intrapatient differences in absorption (area under the plasma concentration time curve [AUC(0-12h)]) after a 7-day period of concomitant treatment with erlotinib, with or without esomeprazole, with either cola or water. At the 7th and 14th day, patients were hospitalized for 1 day for pharmacokinetic sampling. Results Twenty-eight evaluable patients were included in the analysis. In patients treated with erlotinib and esomeprazole with cola, the mean AUC(0-12h) increased 39% (range, -12% to 136%; P = .004), whereas in patients not treated with the PPI, the mean AUC(0-12h) was only slightly higher (9%; range, -10% to +30%; P = .03) after erlotinib intake with cola. Conclusion Cola intake led to a clinically relevant and statistically significant increase in the bioavailability of erlotinib during esomeprazole treatment. In patients not treated with the PPI, the effects of cola were marginal. These findings can be used to optimize the management of drug-drug interactions between PPIs and erlotinib. (C) 2016 by American Society of Clinical Oncology
AB - Purpose Erlotinib depends on stomach pH for its bioavailability. When erlotinib is taken concurrently with a proton pump inhibitor (PPI), stomach pH increases, which results in a clinically relevant decrease of erlotinib bioavailability. We hypothesized that this drug-drug interaction is reversed by taking erlotinib with the acidic beverage cola. The effects of cola on erlotinib bioavailability in patients not treated with a PPI were also studied. Patients and Methods In this randomized, cross-over, pharmacokinetic study in patients with non-small-cell lung cancer, we studied intrapatient differences in absorption (area under the plasma concentration time curve [AUC(0-12h)]) after a 7-day period of concomitant treatment with erlotinib, with or without esomeprazole, with either cola or water. At the 7th and 14th day, patients were hospitalized for 1 day for pharmacokinetic sampling. Results Twenty-eight evaluable patients were included in the analysis. In patients treated with erlotinib and esomeprazole with cola, the mean AUC(0-12h) increased 39% (range, -12% to 136%; P = .004), whereas in patients not treated with the PPI, the mean AUC(0-12h) was only slightly higher (9%; range, -10% to +30%; P = .03) after erlotinib intake with cola. Conclusion Cola intake led to a clinically relevant and statistically significant increase in the bioavailability of erlotinib during esomeprazole treatment. In patients not treated with the PPI, the effects of cola were marginal. These findings can be used to optimize the management of drug-drug interactions between PPIs and erlotinib. (C) 2016 by American Society of Clinical Oncology
U2 - 10.1200/JCO.2015.65.2560
DO - 10.1200/JCO.2015.65.2560
M3 - Article
C2 - 26858332
SN - 0732-183X
VL - 34
SP - 1309
EP - 1314
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 12
ER -