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

  • Alexander Hoemme
  • Holger Barth
  • Manuel Haschke
  • Stephan Krähenbühl
  • Florian Strasser
  • Claudia Lehner
  • Alexander von Kameke
  • Thomas Wälti
  • Beat Thürlimann
  • Martin Früh
  • Christoph Driessen
  • Markus JoergerEmail author
Original Article


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.


Drug safety Drug interactions Breast cancer Lung cancer Anticancer drugs 


Compliance with ethical standards

Conflict of interest

The authors declare no competing interests concerning this work.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alexander Hoemme
    • 1
    • 2
  • Holger Barth
    • 1
  • Manuel Haschke
    • 3
    • 4
  • Stephan Krähenbühl
    • 5
  • Florian Strasser
    • 2
  • Claudia Lehner
    • 6
  • Alexander von Kameke
    • 7
  • Thomas Wälti
    • 8
  • Beat Thürlimann
    • 9
  • Martin Früh
    • 2
  • Christoph Driessen
    • 2
  • Markus Joerger
    • 2
    • 10
    Email author
  1. 1.Institute of Pharmacology and ToxicologyUniversity of Ulm Medical CenterUlmGermany
  2. 2.Department of Medical Oncology and HematologyCantonal HospitalSt. GallenSwitzerland
  3. 3.Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
  4. 4.Institute of PharmacologyUniversity of BernBernSwitzerland
  5. 5.Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselBaselSwitzerland
  6. 6.Hospital Pharmacy, Cantonal HospitalSt. GallenSwitzerland
  7. 7.Department of Information TechnologyCantonal HospitalSt. GallenSwitzerland
  8. 8.HCI Solutions Inc.BernSwitzerland
  9. 9.Breast CenterCantonal HospitalSt. GallenSwitzerland
  10. 10.Medical Oncology and Clinical PharmacologyCantonal HospitalSt. GallenSwitzerland

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