Drug Interaction Report

CONTRAINDICATED: Talimogene laherparepvec is a live, attenuated herpes simplex virus. Administration during immunosuppressant or intense antineoplastic therapy may be associated with a risk of potentially life-threatening disseminated herpetic infection due to enhanced virus replication in the presence of diminished immune competence. Patients may be immunosuppressed if they have recently received or are receiving alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents, or long-term topical or inhaled corticosteroids.

MANAGEMENT: Talimogene laherparepvec should not be used in patients receiving immunosuppressive therapy or cancer chemotherapy. Treatment with talimogene laherparepvec may need to be deferred until after such therapy is discontinued and the patient's immune system has sufficiently recovered.

ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of bosutinib. When given with a high-fat meal, bosutinib peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 1.8- and 1.7-fold, respectively.

GENERALLY AVOID: Coadministration with grapefruit juice is likely to increase the plasma concentrations of bosutinib, which is primarily metabolized by CYP450 3A4. However, the interaction has not been studied. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit.

MANAGEMENT: Bosutinib should be administered with a meal. The consumption of grapefruit, grapefruit juice, and supplements that contain grapefruit extract should be avoided.