Guillaume Beinse1, Delphine Reitter2, Lauriane Segaux3, Muriel Carvahlo-Verlinde2, Benoit Rousseau4, Christophe Tournigand4, Tristan Cudennec5, Marie Laurent6, Pascaline Boudou-Rouquette7, Elena Paillaud8, Florence Canouï-Poitrine3, Philippe Caillet9. 1. AP-HP, Henri-Mondor Hospital, Department of Internal and Geriatric Medicine, Sud-Val-de-Marne Geriatric Oncology Unit, Créteil, France; AP-HP, Henri-Mondor Hospital, Departement of Drug Development, Clinical Pharmacology in Oncology, France. 2. AP-HP, Henri-Mondor Hospital, Department of Pharmacy, Créteil, France. 3. University Paris-Est, Paris Est Créteil University (UPEC), CEpiA (Clinical Epidemiology and Ageing), EA 7376-IMRB, Créteil, France; AP-HP, Henri-Mondor Hospital, Department of Public Health, Clinical Research Unit (URC-Mondor), Créteil, France. 4. AP-HP, Henri-Mondor Hospital, Departement of Drug Development, Clinical Pharmacology in Oncology, France; AP-HP, Henri-Mondor Hospital, Department of Medical Oncology, Créteil, France. 5. AP-HP, Ambroise Paré Hospital, Department of Geriatrics, Boulogne-Billancourt, France. 6. AP-HP, Henri-Mondor Hospital, Department of Internal and Geriatric Medicine, Sud-Val-de-Marne Geriatric Oncology Unit, Créteil, France; University Paris-Est, Paris Est Créteil University (UPEC), CEpiA (Clinical Epidemiology and Ageing), EA 7376-IMRB, Créteil, France. 7. AP-HP, Cochin Hospital, Department of Medical Oncology, ARIANE, Paris, France. 8. University Paris-Est, Paris Est Créteil University (UPEC), CEpiA (Clinical Epidemiology and Ageing), EA 7376-IMRB, Créteil, France; AP-HP, Hopital Europeen Georges Pompidou, Department of Geriatrics, Paris, France. 9. University Paris-Est, Paris Est Créteil University (UPEC), CEpiA (Clinical Epidemiology and Ageing), EA 7376-IMRB, Créteil, France; AP-HP, Hopital Europeen Georges Pompidou, Department of Geriatrics, Paris, France. Electronic address: philippe.caillet@aphp.fr.
Abstract
BACKGROUND: Because of comorbidities and polypharmacy, older patients with cancer have a greater risk of iatrogenic events. We aimed to characterize potential drug-drug interactions (PDIs) and the risk of unplanned hospitalization in older patients with cancer treated with antineoplastic agents (ANAs). METHODS: We analyzed all older patients (≥70 years) from the prospective ELCAPA cohort referred for geriatric assessment (2007-2014) prior to treatment with ANA at Henri Mondor Hospital (Créteil, France). PDIs were identified using Lexicomp®, and Theriaque® for French medications. Factors associated with PDIs, and association between PDIs and unplanned hospitalization in the 6 months following geriatric assessment were analyzed using ordered multivariate logistic regression (MLR). RESULTS: We included 442 patients (median [interquartile range] age: 77 years [74-80]); number of medications/patient/day: 6 [3-8]); ECOG-PS ≤ 2: 79%; metastasis: 70%). Most patients had a digestive tract cancer (colorectal: 22%; upper digestive tract: 23%). We identified 1742 PDIs; 76.5% of patients had ≥1 PDI; 13% of the PDIs involved an ANA. In a multivariate analysis, cardiovascular disorders (ischemic heart disease, heart failure, atrial fibrillation and/or arterial hypertension) were independently associated with PDIs (p < .001, after adjustment for polypharmacy and tumor site/stage). A high number of PDIs between two daily medications was independently associated with the risk of unplanned hospitalization (adjusted-odds ratio [95% confidence interval] per PDI: 1.05 [1.00;1.11], p = .05), while polypharmacy was not. CONCLUSION: Patients with cardiovascular comorbidities were more likely to have a PDI. A higher number of PDIs may be an independent risk factor for early unplanned hospitalization.
BACKGROUND: Because of comorbidities and polypharmacy, older patients with cancer have a greater risk of iatrogenic events. We aimed to characterize potential drug-drug interactions (PDIs) and the risk of unplanned hospitalization in older patients with cancer treated with antineoplastic agents (ANAs). METHODS: We analyzed all older patients (≥70 years) from the prospective ELCAPA cohort referred for geriatric assessment (2007-2014) prior to treatment with ANA at Henri Mondor Hospital (Créteil, France). PDIs were identified using Lexicomp®, and Theriaque® for French medications. Factors associated with PDIs, and association between PDIs and unplanned hospitalization in the 6 months following geriatric assessment were analyzed using ordered multivariate logistic regression (MLR). RESULTS: We included 442 patients (median [interquartile range] age: 77 years [74-80]); number of medications/patient/day: 6 [3-8]); ECOG-PS ≤ 2: 79%; metastasis: 70%). Most patients had a digestive tract cancer (colorectal: 22%; upper digestive tract: 23%). We identified 1742 PDIs; 76.5% of patients had ≥1 PDI; 13% of the PDIs involved an ANA. In a multivariate analysis, cardiovascular disorders (ischemic heart disease, heart failure, atrial fibrillation and/or arterial hypertension) were independently associated with PDIs (p < .001, after adjustment for polypharmacy and tumor site/stage). A high number of PDIs between two daily medications was independently associated with the risk of unplanned hospitalization (adjusted-odds ratio [95% confidence interval] per PDI: 1.05 [1.00;1.11], p = .05), while polypharmacy was not. CONCLUSION:Patients with cardiovascular comorbidities were more likely to have a PDI. A higher number of PDIs may be an independent risk factor for early unplanned hospitalization.
Authors: F Ranchon; C Rioufol; H Prely; C Herledan; A G Caffin; A Baudouin; V Larbre; M Maire; V Schwiertz; N Vantard Journal: J Cancer Res Clin Oncol Date: 2021-04-29 Impact factor: 4.553
Authors: Heidi D Klepin; Can-Lan Sun; David D Smith; Rawad Elias; Kelly M Trevino; Ashley Leak Bryant; Daneng Li; Christian Nelson; William P Tew; Supriya G Mohile; Ajeet Gajra; Cynthia Owusu; Cary Gross; Stuart M Lichtman; Vani V Katheria; Hyman B Muss; Andrew E Chapman; Harvey Jay Cohen; Arti Hurria; William Dale Journal: JCO Oncol Pract Date: 2021-04-21