Prognostic impact of polypharmacy and drug interactions in patients with advanced cancer.

Hoemme, Alexander; Barth, Holger; Haschke, Manuel Martin; Krähenbühl, Stephan; Strasser, Florian; Lehner, Claudia; von Kameke, Alexander; Wälti, Thomas; Thürlimann, Beat; Früh, Martin; Driessen, Christoph; Joerger, Markus (2019). Prognostic impact of polypharmacy and drug interactions in patients with advanced cancer. Cancer chemotherapy and pharmacology, 83(4), pp. 763-774. Springer 10.1007/s00280-019-03783-9

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Haschke, Manuel Martin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0344-5704

Publisher:

Springer

Language:

English

Submitter:

Tobias Tritschler

Date Deposited:

25 Apr 2019 12:57

Last Modified:

06 Jul 2022 14:59

Publisher DOI:

10.1007/s00280-019-03783-9

PubMed ID:

30684020

Uncontrolled Keywords:

Anticancer drugs Breast cancer Drug interactions Drug safety Lung cancer

BORIS DOI:

10.7892/boris.125448

URI:

https://boris.unibe.ch/id/eprint/125448

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