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Polypharmacy as a prognostic factor in older patients with advanced non-small-cell lung cancer treated with anti-PD-1/PD-L1 antibody-based immunotherapy

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

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Acknowledgements

We would like to thank Enago (https://www.enago.jp/) for the English language review.

Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. 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

    Taiki Hakozaki, Yukio Hosomi, Akihiro Shimizu, Rui Kitadai & Kie Mirokuji

  2. Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1Tsukiji, Chuo, Tokyo, 105-0045, Japan

    Yusuke Okuma

Authors
  1. Taiki Hakozaki
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  2. Yukio Hosomi
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  3. Akihiro Shimizu
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  4. Rui Kitadai
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  5. Kie Mirokuji
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  6. Yusuke Okuma
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Contributions

TH and AS conceptualized this study. TH, AS, and RK acquired the clinical data. TH, YH, AS, KM, and YO were responsible for the interpretation of the data. TH and YH drafted the manuscript. All authors have read and approved the current version of the manuscript.

Corresponding author

Correspondence to Yukio Hosomi.

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Conflict of interest

YH has received personal fees from AstraZeneca, Eli Lilly Japan, Taiho Pharmaceutical, Chugai Pharmaceutical, Ono Pharmaceutical, Bristol-Myers Squibb, Kyowa Kirin, and CSL Behring, outside the submitted work. YO has received personal fees from Chugai Pharmaceutical and Takeda Oncology, outside the submitted work. No other potential conflicts of interest were reported.

Ethics approval

The study protocol was approved by the Ethics Committee of the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital (approval number: 2342) and conducted in accordance with the tenets of the Declaration of Helsinki.

Availability of data and material

The datasets used and analyzed during the present study are available from the corresponding author on reasonable request.

Prior presentation

Presented in part at European Society for Medical Oncology Asia Congress 2019, Singapore, November 23, 2019.

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Supplementary file1 (DOCX 14 kb)

432_2020_3252_MOESM2_ESM.tif

Supplementary file2 (TIF 79 kb) Supplemental figure 1. Survival analysis of patients with PIM and those without PIM. Estimated Kaplan–Meier survival curves for (A) progression-free survival and (B) overall survival, comparing PIM (+) patients (n = 60) and PIM (−) patients (n = 97)

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Hakozaki, T., Hosomi, Y., Shimizu, A. et al. Polypharmacy as a prognostic factor in older patients with advanced non-small-cell lung cancer treated with anti-PD-1/PD-L1 antibody-based immunotherapy. J Cancer Res Clin Oncol 146, 2659–2668 (2020). https://doi.org/10.1007/s00432-020-03252-4

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  • DOI: https://doi.org/10.1007/s00432-020-03252-4

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