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Breast cancer, placing drug interactions in the spotlight: is polypharmacy the cause of everything?

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Abstract

Purpose

Breast cancer is the most prevalent and lethal cancer among women. Forty-one percent of cases occur in people ≥ 70 years, hindering their treatment given its comorbidities and polypharmacy (PP). Potential drug–drug interactions (PDDI) were analyzed in elderly breast cancer patients between daily and oncospecific treatments and their associations with Age, BMI, Mini Nutritional Assessment (MNA), Frailty categorization, PP, and adverse effects.

Patients/methods

A cohort of 77 patients ≥ 70 years with breast cancer who underwent a Comprehensive Geriatric Assessment (CGA) were included. Clinical characteristics were collected using medical records. PDDI between treatments were analyzed using two databases. Data were assessed using linear regression, Chi-square, Mann–Whitney U, and Kruskal–Wallis tests. Finally, a multivariate logistic regression model was built and tested to predict adverse effects.

Results

From 719 PDDI, 530 (74%) were moderate (r2 = 0.72) and the median number of drugs during oncospecific treatment (r2 = 0.73) was 9 (range 3–26). Overall, 59 patients (77%) had adverse effects associated with Frailty categorization and MNA (p < 0.05). The distribution of major, moderate, minor, and total PDDI was associated with PP at CGA and during oncospecific treatment (p < 0.05). Moreover, it was verified that Frailty categorization protects from adverse effects given the intervention made at CGA.

Conclusions

CGA should be applied in oncologic elderly patients to assess clinical outcomes and categorize them according to their frailty but also to analyze PDDI. Furthermore, we encourage the use of the model in clinical practice for predicting the occurrence of adverse effects, improving therapeutic conciliation.

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Availability of data and material

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors wish to thank Sara Escudero, Pau Benito, and Ana Digón for their assistance throughout this project.

Funding

None.

Author information

Authors and Affiliations

  1. Universitat Pompeu Fabra-Universitat Autònoma de Barcelona, Barcelona, Spain

    José Alberto Domínguez-Alonso

  2. Hospital Del Mar, Barcelona, Spain

    David Conde-Estévez & Maria Pi-Figueras

  3. Departament de Dinàmica de la Terra i de l’Oceà, Facultat de Ciències de la Terra, Universitat de Barcelona, Barcelona, Spain

    David Bosch

  4. Medical Oncology Department, Hospital del Mar, Barcelona, Spain

    Ignacio Tusquets

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  1. José Alberto Domínguez-Alonso
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Corresponding author

Correspondence to José Alberto Domínguez-Alonso.

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Conflict of interest

David Conde-Estévez declares: Advisory role: Boehringer-Ingelheim, MSD; Travel and educational expenses: BMS. Ignacio Tusquets declares: Advisory role: Roche, Pfizer, Celgene; Travel and educational expenses: Roche.

Ethics approval

This study was approved by the clinical investigation ethics committee of the Hospital del Mar (CEIC-Parc de Salut Mar, no. CEIC 2019/9015-I) and has been performed in accordance with the ethical standards of the Declaration of Helsinki (Fortaleza, Brazil, October 2013).

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Written consent was not necessary, since the study does not involve neither biological samples nor interventions on individuals.

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Electronic supplementary material

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Supplementary file1 Correlation between number of moderate PDDI and number of drugs (r2 = 0.72) (TIFF 2254 kb)

Supplementary file2 Correlation between number of total PDDI and number of drugs (r2 = 0.73) (TIFF 2307 kb)

12094_2020_2386_MOESM3_ESM.tiff

Supplementary file3 Mean AUC of the 10,000 created models on the 10,000 stratified randomly sampled training and test sets (TIFF 1612 kb)

Supplementary file4 (DOCX 17 kb)

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Domínguez-Alonso, J.A., Conde-Estévez, D., Bosch, D. et al. Breast cancer, placing drug interactions in the spotlight: is polypharmacy the cause of everything?. Clin Transl Oncol 23, 65–73 (2021). https://doi.org/10.1007/s12094-020-02386-8

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  • DOI: https://doi.org/10.1007/s12094-020-02386-8

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