Lung cancer predominantly affects older adults who already experience comorbidities and are at increased risk of drug-drug interactions (DDIs) due to polypharmacy. Traditional DDI assessments often do not fully capture complex co-medication patterns observed in real-world practice due to the risk of introducing confounding factors. This study used U.S. Optum claims data from 2019 to 2024 to characterize co-medication patterns in predominately non-small cell lung cancer (NSCLC) patients and map enzyme- and transporter-mediated liabilities across commonly used medications, chemotherapy agents, and biomarker-driven therapies. Potential DDI liabilities were further prioritized using a semi-quantitative clinical framework based on perpetrator strength, substrate sensitivity, narrow therapeutic index status, and available evidence. Frequently used medications included disease-specific supportive therapies such as ondansetron and dexamethasone, as well as treatments for common U.S. comorbidities such as cardiovascular and endocrine disorders. Many of the co-medications were substrates, inhibitors, and inducers of pathways critical for NSCLC treatments such as CYP3A, CYP2D6, P-gp, and OATP1B and additional risks were identified when giving treatments with acid-reducing agents or QT-prolonging drugs. These findings demonstrate how integrating real-world data (RWD) can strengthen DDI assessment by improving clinical trial design, informing risk-mitigation strategies, and supporting more patient-centric drug development.

AimThis systematic review and meta-analysis evaluated the efficacy and safety of palonosetron versus ondansetron for CINV prevention.MethodsA systematic review and meta-analysis of randomized controlled trials comparing palonosetron and ondansetron in patients receiving chemotherapy was conducted. PubMed, Embase, Scopus, and Cochrane CENTRAL were searched until October 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane ROB 2 tool. Primary outcome was complete response in acute (0-24 h), delayed (24-120 h), and overall (0-120 h) phases. Secondary outcomes included complete control, adverse events, nausea control, rescue medication use, and emetic episodes. Random-effects models were applied, and evidence certainty was assessed using GRADE. This review was registered in PROSPERO (CRD420251172577).ResultsAmong 11 included studies, all were eligible for meta-analysis. Palonosetron showed higher pooled complete response rates than ondansetron in the acute (RR 1.06; 95% CI 1.02 to 1.11), delayed (RR 1.30; 95% CI 1.17 to 1.43), and overall phases (RR 1.29; 95% CI 1.17 to 1.42). Pooled complete control rates showed improvements mainly in the delayed phase. No significant differences were found in pooled adverse event rates, headache, constipation, rescue medication use, or emetic episodes. Sensitivity analyses confirmed stability of pooled estimates; subgroup analyses showed consistent effects across populations and chemotherapy types. Heterogeneity was low, and certainty of evidence ranged from moderate to high.ConclusionsPalonosetron demonstrates superior pooled complete response rates compared with ondansetron across all phases, with particularly significant improvements in delayed-phase control response, and a comparable safety profile.

Extemporaneously compounded oral liquids are essential for patients unable to swallow solid dosage forms, although ensuring stability in aqueous systems remains challenging. This study evaluated the chemical, physical, and microbiological stability of formulations containing topiramate, omeprazole, gabapentin, ondansetron, and levofloxacin prepared in Flavor Sweet™ SF and Flavor Plus™, also known as Syra Sweet™ SF and Syra Plus™. Stability was assessed over 90 days at room temperature and under refrigeration using validated UHPLC methods, along with physical and microbiological analyses. Gabapentin, ondansetron, omeprazole, and topiramate remained stable for 90 days under both conditions, while levofloxacin was stable for 60 days at room temperature and 90 days refrigerated. All formulations showed consistent pH and acceptable microbiological quality, although precipitation in some samples led to discontinuation of analysis. These results support the suitability of the vehicle system and highlight the importance of formulation parameters in stability and beyond-use dating.