Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1Tsukiji, Chuo, Tokyo, 105-0045, Japan.
J Cancer Res Clin Oncol. 2020 Oct;146(10):2659-2668. doi: 10.1007/s00432-020-03252-4. Epub 2020 May 27.
Polypharmacy is a common problem among older adults. However, its prevalence and impact on the clinical outcomes of anticancer treatment, such as survival and adverse events, in older patients with advanced cancer have not been well investigated.
We retrospectively reviewed data from Japanese patients treated with an immune checkpoint inhibitor (ICI) for advanced or recurrent non-small-cell lung cancer (NSCLC) between 2016 and 2019.
Among 157 older (aged ≥ 65 years) patients, the prevalence of polypharmacy, defined as ≥ 5 medications, was 59.9% (94/157). The prevalence of potentially inappropriate medication use, according to the screening tool of older people's prescription (STOPP) criteria version 2, was 38.2% (60/157). The median progression-free survival (PFS) in patients with and without polypharmacy was 3.7 and 5.5 months, respectively (P = 0.0017). The median overall survival (OS) in patients with and without polypharmacy was 9.5 and 28.1 months, respectively (P < 0.001). Multivariate analysis revealed marked associations between polypharmacy and OS, but no significant associations between polypharmacy and PFS. Polypharmacy was not associated with immune-related adverse events but was associated with higher rate of unexpected hospitalizations during ICI treatment (59.6% vs. 31.7%, P < 0.001).
Polypharmacy is an independent prognostic factor in older patients with advanced NSCLC treated with ICI. Also, polypharmacy could be utilized as a simple indicator of patients' comorbidities and symptoms or as a predictive marker of unexpected hospitalizations during ICI treatment.
多药治疗是老年患者中常见的问题。然而，在老年晚期癌症患者中，其在癌症治疗的临床结局（如生存和不良事件）中的普遍性及其影响尚未得到充分研究。
我们回顾性分析了 2016 年至 2019 年间接受免疫检查点抑制剂（ICI）治疗晚期或复发性非小细胞肺癌（NSCLC）的日本患者的数据。
在 157 名老年（≥65 岁）患者中，多药治疗的患病率（定义为≥5 种药物）为 59.9%（94/157）。根据老年人用药筛选工具（STOPP）标准 2 版，潜在不适当药物使用的患病率为 38.2%（60/157）。有和无多药治疗的患者无进展生存期（PFS）分别为 3.7 和 5.5 个月（P=0.0017）。有和无多药治疗的患者总生存期（OS）分别为 9.5 和 28.1 个月（P<0.001）。多变量分析显示，多药治疗与 OS 之间存在显著关联，但与 PFS 之间无显著关联。多药治疗与免疫相关不良事件无关，但与 ICI 治疗期间意外住院的发生率较高相关（59.6%比 31.7%，P<0.001）。
多药治疗是接受 ICI 治疗的老年晚期 NSCLC 患者的独立预后因素。此外，多药治疗可用作患者合并症和症状的简单指标，或用作 ICI 治疗期间意外住院的预测指标。
