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Predictive factors for the development of irinotecan-related cholinergic syndrome using ordered logistic regression analysis

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Abstract

Cholinergic syndrome is an acute adverse reaction associated with irinotecan. Development of cholinergic syndrome can be ameliorated or prevented by administering various anticholinergics, including atropine sulfate or scopolamine butylbromide. Although many of the side effects are transient and non-life-threatening, their onset is painful and can lower a patient’s quality of life (QoL). This retrospective study was performed to identify predictive factors of the development of irinotecan-related cholinergic syndrome in order to develop future strategies for improving the QoL of patients undergoing chemotherapy. We enrolled 150 cancer patients who underwent chemotherapy, which included irinotecan, in our outpatient chemotherapy center between October 2014 and January 2017. For regression analysis, variables related to the development of irinotecan-related cholinergic syndrome were extracted from the patient’s clinical records. The degree of cholinergic syndrome was classified as follows: grade 0 = not developed; grade 1 = developed but did not require anticholinergic drugs; and grade 2 = developed and required anticholinergic drugs or stopping the chemotherapy due to cholinergic syndrome. Multivariate ordered logistic regression analysis was performed to identify predictive factors for the development of irinotecan-related cholinergic syndrome. Threshold measurements were determined using a receiver operating characteristic analysis (ROC) curve. Significant factors identified for the development of cholinergic syndrome included female sex [odds ratio (OR) 2.183, 95% confidence interval (CI) 1.010–4.717; P = 0.0471] and irinotecan dose (OR 1.014, 95% Cl 1.007–1.021; P = 0.0001). ROC curve analysis of the group likely to develop cholinergic syndrome indicated that the threshold for the irinotecan dose was 175 mg or above (area under the curve = 0.69). In conclusion, female sex and irinotecan dose were identified as significant predictors of the development of cholinergic syndrome.

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Authors and Affiliations

  1. Departments of Pharmacy, University Hospital, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Yuko Kanbayashi, Yuki Nakajima & Yusuke Tabuchi

  2. Departments of Outpatient Oncology Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Yuko Kanbayashi, Takeshi Ishikawa, Motohiro Kanazawa, Yuki Nakajima, Rumi Kawano, Tomoko Yoshioka & Tetsuya Taguchi

  3. Departments of Pain Treatment & Palliative Care Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Yuko Kanbayashi, Tomoko Yoshioka & Toyoshi Hosokawa

  4. Departments of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Takeshi Ishikawa & Naohisa Yoshida

  5. Departments of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Motohiro Kanazawa

  6. Departments of Nursing, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Rumi Kawano & Tomoko Yoshioka

  7. Departments of Pain Management and Palliative Care Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Toyoshi Hosokawa

  8. Departments of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Koichi Takayama

  9. Departments of Endocrine and Breast Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Tetsuya Taguchi

Authors
  1. Yuko Kanbayashi
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  2. Takeshi Ishikawa
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  3. Motohiro Kanazawa
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  4. Yuki Nakajima
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  5. Yusuke Tabuchi
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  7. Tomoko Yoshioka
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  8. Naohisa Yoshida
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  9. Toyoshi Hosokawa
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  11. Tetsuya Taguchi
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Corresponding author

Correspondence to Yuko Kanbayashi.

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Conflict of interest

All authors declare that they have no conflict of interest concerning this work.

Ethical approval

The Medical Ethics Review Committee of Kyoto Prefectural University of Medicine approved this study. All procedures were performed in accordance with the ethical standards of the Kyoto Prefectural University of Medicine Institutional Medical Ethics Review Committee and the 1964 Helsinki Declaration and its later amendments. No prospective studies with human participants or animals were performed by any of the authors for this article.

Informed consent

Given the retrospective nature of this work, informed consent was waived for the individual participants included in the study in accordance with the standards of the Kyoto Prefectural University of Medicine Institutional Medical Ethics Review Committee.

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Kanbayashi, Y., Ishikawa, T., Kanazawa, M. et al. Predictive factors for the development of irinotecan-related cholinergic syndrome using ordered logistic regression analysis. Med Oncol 35, 82 (2018). https://doi.org/10.1007/s12032-018-1142-3

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  • DOI: https://doi.org/10.1007/s12032-018-1142-3

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