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Prognostic impact of drug interactions in patients with advanced cancer

Date

09 Sep 2017

Session

Supportive and palliative care

Presenters

Markus Joerger

Citation

Annals of Oncology (2017) 28 (suppl_5): v497-v501. 10.1093/annonc/mdx382

Authors

M. Joerger1, A. Hömme2, M. Haschke3, S. Krähenbühl3, F. Strasser1, C. Lehner4, A. von Kameke5, T. Wälti6, B. Thürlimann7, M. Früh1, C. Driessen1

Author affiliations

  • 1 Medical Oncology & Hematology, Cantonal Hospital, 9007 - St. Gallen/CH
  • 2 Institute Of Pharmacology & Toxicology, University of Ulm, 89081 - Ulm/DE
  • 3 Clinical Pharmacology & Toxicology, University Hospital Basel and Department of Biomedicine, University of Basel, 4003 - Basel/CH
  • 4 Pharmacy, Cantonal Hospital, 9007 - St. Gallen/CH
  • 5 Information Technology (it), Cantonal Hospital, 9007 - St. Gallen/CH
  • 6 Hci Solutions Inc., HCI Solutions Inc., 3027 - Bern/CH
  • 7 Breast Center, Cantonal Hospital, 9007 - St. Gallen/CH
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Background

The risk of drug-drug interactions (DDI) increases with the number of comedications. The prognostic impact of DDI in oncology is poorly understood.

Methods

We included 105 patients with advanced NSCLC, 100 patients with advanced ER-negative breast cancer (BC) and 100 hospice inpatients (HO) with advanced malignancies between 2010 and 2015. Data collected included all anticancer and non-anticancer drugs received, age, gender, presence of CNS metastases, smoking status, ECOG performance status (PS), Charlson comorbidity score and overall survival (OS) from the time of incurable cancer. Potential DDI were assessed using the hospINDEX of all drugs approved in Switzerland in combination with the DDI software - flycicle mode (HCI Solutions, Bern, Switzerland). Primary study objective was to assess the prognostic value of the severity of DDI per patient cohort using Kaplan-Meier statistics, uni- and multivariate Cox regression models. The study had a power of 84% to detect a survival difference of 25%.

Results

The median number of drugs was 5 (range 0 to 15) in all patients, lowest in BC (4) and highest in HO (6). A major risk for DDI was detected in 74 patients (24.3%) overall, including 29 NSCLC patients (27.6%), 25 BC patients (25.0%) and 20 HO patients (20%). The number of drugs was significantly associated with the risk of DDI (p 

Conclusions

Severity of DDI is a significant and clinically relevant prognostic factor in advanced BC patients. Prospective trials should evaluate the potential benefit of avoiding polypharmacy in this group of patients. In the meantime, increased caution with polypharmacy seems warranted when treating patients with advanced cancer.

Clinical trial identification

2016-00283 (BASEC, national trial identifier)

Legal entity responsible for the study

Markus Joerger MD-PhD ClinPharm

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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