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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

abstract 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.
   
citation 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.
   
type journal paper/review (English)
date of publishing 25-01-2019
journal title Cancer Chemother Pharmacol (83/4)
ISSN electronic 1432-0843
pages 763-774
PubMed 30684020
DOI 10.1007/s00280-019-03783-9