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    Expert Nurse
    Avatar photoLisa Kottschade

      There are a lot of folks who are using alternative medication for the treatment of their cancers. I’m wondering what everyone’s advice is to their patients if they are going to be on systemic therapy for their metastatic melanoma. Looking forward to your responses.

      Thanks you!

      Expert Nurse
      Avatar photoVirginia Seery

        Great topic. We ask our patients on systemic therapy to avoid herbal medications, particularly antioxidants, as there is concern they may decrease the efficacy of treatment. Being on multiple meds (prescribed, OTC and herbals) makes it more difficult to sort out the source of side effects when they occur. This is definitely an area where more research is needed given the number of people on alternative meds.

        Expert Nurse
        Avatar photoMollie Reed

          We try to have them avoid herbals. It’s required when on a trial, but even when on standard therapy, it’s best. I usually just explain that we’re unsure of the side effects of the herbals and that they’re not studied by the FDA. I had one patient on Tafinlar plus Mekinist that had been on it for years when his ALT and AST spiked….high. We were so worried about tox or PD. Then he admitted that he had started herbals. He held them and about a week later, LFTs were significantly better. Just one example, but again, best to avoid!

          Expert Nurse
          Avatar photoKathleen Madden

            Such an important topic, as many supplements are OTC and unregulated. In our practice, we first explore if supplements being used were recommended by a HCP who has training and experience with supplements, herbals, homeopathy or essential oils or if a pt has added “supplements” themselves.
            We investigate the intent of the “supplements” and evaluate which may safely remain in a patients’ regimen in relation to treatment. Sometimes, pts make choices of supplements based on what they think they need without real guidance or input as to how the supplements may interact with one another or prescribed medications. As Mollie pointed out some supplements especially poly supplements can interfere with oral targeted therapies or set up a renal or hepato –toxic situation in respect to immune checkpoint inhibitors. Additionally, the growing access to CBD (cannabidiol) oil and ingestion of CBD which is a powerful CYP450 3A 4&5 inhibitor can interfere with other oral agents causing toxicity with prescribed medications.

            Expert Nurse
            Avatar photoKrista Rubin

              Kathy- Thanks for the info about CBD being a CYP inhibitor! Very important.
              As more and more states legalize these products, this type of info sharing is incredibly helpful!

              Expert Nurse
              Avatar photoMollie Reed

                Also, THC is highly protein bound, so it certainly could compete with other drugs in that aspect as well. These are certainly things to think about as these type of alternative therapies become more and more popular.

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