• G D Marijn Veerman, Koen G A M Hussaarts, Jansman Frank G A FGA Department of Clinical Pharmacy, Deventer Hospital, Deventer, Netherlands; Groningen Research Institute of Pharmacy, University Groningen, Groningen, Stijn W L Koolen, van Leeuwen Roelof W F RWF Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands; Department of Hospital Pharmacy, Erasmus MC, Rotterdam, Ne, and Mathijssen Ron H J RHJ Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands..
• Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands. Electronic address: g.veerman@erasmusmc.nl.
• Lancet Oncol. 2020 May 1; 21 (5): e265-e279.

AbstractDuring the past two decades, small-molecule kinase inhibitors have proven to be valuable in the treatment of solid and haematological tumours. However, because of their oral administration, the intrapatient and interpatient exposure to small-molecule kinase inhibitors (SMKIs) is highly variable and is affected by many factors, such as concomitant use of food and herbs. Food-drug interactions are capable of altering the systemic bioavailability and pharmacokinetics of these drugs. The most important mechanisms underlying food-drug interactions are gastrointestinal drug absorption and hepatic metabolism through cytochrome P450 isoenzymes. As food-drug interactions can lead to therapy failure or severe toxicity, knowledge of these interactions is essential. This Review provides a comprehensive overview of published studies involving food-drug interactions and herb-drug interactions for all registered SMKIs up to Oct 1, 2019. We critically discuss US Food and Drug Administration (FDA) and European Medicines Agency (EMA) guidelines concerning food-drug interactions and offer clear recommendations for their management in clinical practice.Copyright © 2020 Elsevier Ltd. All rights reserved.

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