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This article discusses the drug interaction between trimethoprim-sulfamethoxazole (cotrimoxazole) and folic acid/folinic acid. The interaction is frequently observed in haemato-oncological patients who are receiving trimethoprim-sulfamethoxazole for Pneumocystis Jiroveci Pneumonia (PJP) prophylaxis while also receiving folinic acid supplementation for their haematological condition. The mechanism of this interaction is the inhibition of dihydrofolate reductase (DHFR) by trimethoprim, which affects the metabolism of folic acid into active tetrahydrofolic acid (THF). While there is limited in vitro and in vivo evidence regarding the rationale of this interaction, it is recommended to prioritize folic acid over folinic acid when combining folates with trimethoprim-sulfamethoxazole prophylaxis for safety reasons. [Extracted from the article]

Aims: To assess whether the exposure–response relation for abiraterone is different in pre‐chemotherapy patients compared to post‐chemotherapy patients with metastatic castration‐resistant prostate cancer (mCRPC). Methods: Data were collected from three clinical studies in mCRPC patients treated with abiraterone acetate. Cox regression analysis was used to determine the relation between abiraterone exposure and survival (progression‐free survival [PFS] and overall survival [OS]). An interaction term was used to test whether chemotherapy pretreatment was an effect modifier. To investigate the effect of the previously defined exposure threshold of 8.4 ng/mL on survival, Kaplan–Meier analysis was used. Results: In total, 98 mCRPC patients were included, of which 78 were pre‐chemotherapy and 20 were post‐chemotherapy patients. Chemotherapy pretreatment in mCRPC setting appears to be an effect modifier. In pre‐chemotherapy patients, no significant association between abiraterone exposure and survival was observed (HR 0.68 [95% CI 0.42–1.10], P =.12 and HR 0.85 [95% CI 0.46–1.60], P =.61, PFS and OS, respectively) and no longer survival was seen for patients with an abiraterone exposure above the predefined threshold. In contrast, a significant association was seen in post‐chemotherapy patients (HR 0.30 [95% CI 0.12–0.74], P =.01 and HR 0.38 [95% CI 0.18–0.82] P =.01, PFS and OS, respectively), with an increased survival when exposed above this threshold. Conclusion: Chemotherapy pretreatment in mCRPC setting modifies the abiraterone exposure–response relation. No relation between abiraterone exposure and survival was seen for pre‐chemotherapy patients. Therefore, potentially lower doses can be used in this setting to prevent overtreatment and reduce financial toxicity. [ABSTRACT FROM AUTHOR]

Introduction: Prostate cancer (PCa) is one of the most common malignancies in men and a major cause of cancer deaths among men worldwide. Prostate specific antigen (PSA) monitoring and histopathological examination of tumor biopsies remain gold standards in PCa diagnostics. These clinical parameters are not well suited for patient stratification, predicting and monitoring treatment response. On the other hand, liquid biopsies offer a unique opportunity to easily isolate tumor-derived material for longitudinal clinical assessment. Areas covered: In this review we focus on the clinical application of novel liquid biomarkers that have the potential to monitor and stratify patients in order to achieve better therapeutic effects and improve clinical outcomes. Enumeration and characterization of circulating tumor cells (CTCs), tumor-educated platelets, exosomes, and cell-free nucleic acids have been studied for their clinical utility in PCa diagnostics, prognostics, monitoring treatment response and guiding treatment choice. Expert opinion: Liquid biomarkers have high potential to be used for prognosis, monitoring treatment response and guiding treatment selection. Although there is a remarkable progress in PCa biomarker discovery, their clinical validation is very limited. Research should be focused on biomarker validation and the incorporation of these biomarkers in clinical practice. [ABSTRACT FROM AUTHOR]

Drug-facilitated sexual assault (DFSA) is a term used to describe incidents of sexual assault in which the victim is incapacitated and/or unable to provide consent to the sexual act as a result of drug or alcohol consumption. There are two types: 'proactive' in which the victim is covertly administered an incapacitating or disinhibiting substance by an assailant for the purpose of sexual assault; and 'opportunistic' in which a perpetrator engages in sexual activity with a victim who is profoundly intoxicated by his or her actions, to the point of near or actual unconsciousness. Alcohol is the drug most commonly found in alleged sexual assault cases. It is followed by non-opiate analgesics, illicit drugs and benzodiazepines. The possibility of DFSA should be considered in sexual assault cases. If there is suspicion, drug and alcohol screening has to be done as soon as possible because delay may lead to false-negative results.