Polypharmacy among Older Advanced Lung Cancer Patients taking EGFR Tyrosine Kinase Inhibitors

Abstract

Aim: Polypharmacy (PP) is a common problem among the older adults and has a potential effect on health-related problems. However, the significance of PP in older advanced non-small cell lung cancer (NSCLC) patients and those on oral moleculartargeted anticancer agents is unclear. Methods: This retrospective study reviewed the records of 334 advanced NSCLC patients who underwent epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment. PP was defined as >=5 concomitant medications. Potentially inappropriate medication (PIM) use was measured using the updated screening tool of older people's prescriptions (STOPP) ver. 2 criteria. We also estimated survival distributions using the Kaplan-Meier method, compared between-group differences using the log-rank test, explored potential predictors of survival using Cox regression, and performed cluster analysis to identify factors affecting multiple-medication use. Results: The PP and PIM use prevalence was 38.4% and 31.9%, respectively. The median overall survival (OS) for PP(+) and PP(-) patients was 19.4 months (95% CI = 14.1-24.8) and 27.3 months (95% CI = 22.6-36.4), respectively (P < 0.001). Multivariate analysis revealed a significant correlation between PP and OS. The frequency of unexpected hospitalization during EGFR-TKI treatment was higher in PP(+) compared to PP(-) patients (49.4% vs. 29.4%; P = 0.0032; OR = 2.34; 95% CI = 1.31-4.23). Conclusion: PP is an independent prognostic factor in older NSCLC patients taking EGFR-TKIs. PP can be used as a simple indicator of such patients' comorbidities and symptoms or as a predictive marker of unexpected hospitalization during treatment.

Prevalence of polypharmacy and potentially inappropriate medication use in older lung cancer patients: A systematic review and meta-analysis

“…Because the patients in ten of the papers were not lung cancer patients, the included population was the same across all trials, and the population was not old, these papers were not included in the analysis. Six papers (Lund et al, 2018;Hakozaki et al, 2020;Hakozaki et al, 2021;Mohamed et al, 2021;Ham et al, 2022;Tian et al, 2022) that satisfied the inclusion criteria were finally added to the study (Figure 1).…”