Background/Objectives: Abiraterone acetate, apalutamide, darolutamide, and enzalutamide, which make up the androgen receptor axis-targeted therapies (ARATs) drug class, are commonly used in the management of prostate cancer. Many patients on ARATs also receive oral antithrombotic therapy (i.e., anticoagulants or antiplatelets). The concomitant use of ARATs and antithrombotic therapies creates the potential for clinically relevant drug–drug interactions, but the literature regarding the actual consequences of these interactions, and guidance for co-prescribing, is limited. We assembled a multidisciplinary panel of experts and provided them with clinical information derived from a comprehensive literature review regarding the drug–drug interactions between ARATs and antithrombotic therapies.Methods: A three-stage modified electronic Delphi process was used to gather and consolidate opinions from the panel. Each stage consisted of up to three rounds of voting to achieve consensus on which ARAT/antithrombotic therapy drug pairs warrant attention, the possible clinical consequences of drug–drug interactions, and suggested actions for management.Results: The panel achieved consensus to avoid 11 ARAT/antithrombotic therapy drug pairs and modify therapy for eight pairs. Assessments relied heavily on pharmacokinetic data and extrapolation from drug–drug interaction studies of similarly metabolized drugs.Conclusions: This e-Delphi process highlights the need for further research into the clinical impact of ARAT/antithrombotic drug interactions. Nonetheless, the suggested actions aim to provide clinicians with a practical framework for therapeutic decision making.
背景/目的：醋酸阿比特龙、阿帕鲁胺、达洛鲁胺和恩扎卢胺构成雄激素受体轴靶向治疗药物类别，常用于前列腺癌的治疗。许多接受ARAT治疗的患者同时接受口服抗血栓治疗。ARAT与抗血栓药物的联用可能产生具有临床意义的药物相互作用，但关于这些相互作用实际后果及联合处方指导的文献有限。我们组建了多学科专家小组，并提供了基于全面文献综述的ARAT与抗血栓药物相互作用临床信息。 方法：采用三阶段改良电子德尔菲法收集并整合专家意见。每个阶段包含最多三轮投票，旨在就以下问题达成共识：哪些ARAT/抗血栓药物组合需重点关注、药物相互作用可能导致的临床后果，以及相应的管理建议。 结果：专家组达成共识，建议避免11种ARAT/抗血栓药物组合，并对8种组合提出治疗方案调整建议。评估主要依据药代动力学数据及对具有相似代谢特性药物的相互作用研究的外推。 结论：本次电子德尔菲研究凸显了进一步探究ARAT/抗血栓药物相互作用临床影响的必要性。尽管如此，提出的管理建议旨在为临床医生提供治疗决策的实用框架。
肿瘤(癌症)患者之家