Drug Interaction Report

MONITOR CLOSELY: Coadministration of loncastuximab tesirine with antineoplastic, immune-modulating, immuno- or myelosuppressive therapies may potentiate the risk of severe infections, myelosuppression, and/or other unintended additive immunosuppressive effects. Serious and fatal infections, including opportunistic infections, as well as myelosuppression, including neutropenia, thrombocytopenia, and anemia have been reported with the use of loncastuximab tesirine. Concomitant use may potentiate these risks. However, clinical data are not available.

MANAGEMENT: The safety and efficacy of loncastuximab tesirine use in combination with other immuno- or myelosuppressive agents have not been evaluated. Patients receiving loncastuximab tesirine should be monitored closely for the development of signs and symptoms of infection and/or myelosuppression. The manufacturers' recommendations and institutional protocols for dosage, treatment regimens, monitoring, and management of toxicities should be consulted.

GENERALLY AVOID: Data from in vitro and animal (mice) studies suggest that green tea may antagonize the cytotoxic effects of bortezomib. Polyphenols in green tea such as (-)-epigallocatechin gallate (EGCG) have been shown to block the proteasome inhibitory action of bortezomib in multiple myeloma and glioblastoma cancer cell lines. The mechanism appears to involve a direct chemical reaction between the boronic acid moiety of bortezomib and the 1,2-benzenediol groups present in certain polyphenols leading to inactivation of bortezomib. However, one group of investigators reported that no antagonism of bortezomib was observed in preclinical in vivo experiments where EGCG plasma concentrations are commensurate with dietary or supplemental intake.

MANAGEMENT: Until more data are available, it may be advisable to avoid or limit consumption of green tea and green tea products during treatment with bortezomib. The interaction has not been demonstrated for other, non-boronic acid proteasome inhibitors.