Prognostic impact of polypharmacy and drug interactions in patients with advanced cancer
Alexander Hoemme, Holger Barth, Manuel Haschke, Stephan Krähenbühl, Florian Strasser, Claudia Lehner, Alexander Von Kameke, Thomas Wälti, Beat Thürlimann, Martin Früh, Christoph Driessen & Markus Joerger
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abstract
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The risk of potential drug-drug interactions (PDI) is poorly studied
in oncology. We included 105 patients with advanced non-small-cell
lung cancer (NSCLC), 100 patients with advanced breast cancer (BC)
and 100 patients of the palliative care unit (PCU) receiving
systemic palliative treatment between 2010 and 2015. All patients
suffered from advanced incurable cancer and received basic
palliative care. PDI were assessed using the hospINDEX of all drugs
approved in Switzerland in combination with a specific drug
interaction software. Primary study objective was to assess the
prognostic impact of PDI per patient cohort using Kaplan-Meier
statistics. The median number of comedications was 5 (range 0-15).
Major-risk PDI were detected in 74 patients (24.3%). The number of
comedications was significantly associated with PDI
(p < 0.0001). Major-risk PDI increased from 14% in
patients with < 4 comedications to 24% in patients with
4-7 comedications, 40% with 8-11 comedications and 67% in patients
with > 11 comedications. Median overall survival (OS) was
8.6 months in NSCLC, 33 months in BC and 1.2 months in PCU patients.
PDI were significantly associated with inferior OS in BC
(HR = 1.32, 95% CI 1.01-1.74,
p = 0.049), but not in NSCLC (HR = 1.11,
95% CI 0.84-1.47, p = 0.45) or PCU
(HR = 1.12, 95% CI 0.86-1.45, p = 0.41).
PDI remained significantly associated with OS in BC
(HR = 1.32, p = 0.049) in the adjusted
model. In conclusion, PDI are frequent in patients with advanced
cancer and increased caution with polypharmacy is warranted when
treating such patients.
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citation
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Hoemme A, Barth H, Haschke M, Krähenbühl S, Strasser F, Lehner C,
Von Kameke A, Wälti T, Thürlimann B, Früh M, Driessen C, Joerger
M. Prognostic impact of polypharmacy and drug interactions in
patients with advanced cancer. Cancer Chemother Pharmacol 2019;
83:763-774.
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type
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journal paper/review (English)
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date of publishing
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25-01-2019
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journal title
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Cancer Chemother Pharmacol (83/4)
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ISSN electronic
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1432-0843
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pages
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763-774
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PubMed
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30684020
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DOI
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10.1007/s00280-019-03783-9
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