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Cancer Chemother Pharmacol. 2019 Apr;83(4):763-774. doi: 10.1007/s00280-019-03783-9. Epub 2019 Jan 25.

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

Author information

1
Institute of Pharmacology and Toxicology, University of Ulm Medical Center, Ulm, Germany.
2
Department of Medical Oncology and Hematology, Cantonal Hospital, St. Gallen, Switzerland.
3
Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
4
Institute of Pharmacology, University of Bern, Bern, Switzerland.
5
Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland.
6
Hospital Pharmacy, Cantonal Hospital, St. Gallen, Switzerland.
7
Department of Information Technology, Cantonal Hospital, St. Gallen, Switzerland.
8
HCI Solutions Inc., Bern, Switzerland.
9
Breast Center, Cantonal Hospital, St. Gallen, Switzerland.
10
Department of Medical Oncology and Hematology, Cantonal Hospital, St. Gallen, Switzerland. markus.joerger@kssg.ch.
11
Medical Oncology and Clinical Pharmacology, Cantonal Hospital, Rorschacherstr. 95, 9007, St. Gallen, Switzerland. markus.joerger@kssg.ch.

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.

KEYWORDS:

Anticancer drugs; Breast cancer; Drug interactions; Drug safety; Lung cancer

PMID:
30684020
DOI:
10.1007/s00280-019-03783-9

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