Drug use affects chemotherapy completion in elderly ovarian cancer patients

In elderly adults with ovarian cancer, potential drug interactions (PDIs) may interfere with chemotherapy completion, while polypharmacy (PP) and potentially inappropriate medications (PIMs) pose mortality risks, a recent study has shown.

Accessing the Danish Gynaecological Cancer Database, researchers identified 3,795 women (median age, 65 years) with epithelial ovarian cancer. Drug use was measured as the number of different drug substances purchased 4 months before diagnosis. This information was used to assess PP, PDIs and PIMs.

Of the participants, 2,219 had a registered date of surgery and underwent chemotherapy either with platinum monotherapy or in combination with a taxane. In multivariate Cox regression analysis, having at least two PDIs was the strongest predictor of not completing a minimum of six courses of chemotherapy (odds ratio, 2.27. 95 percent confidence interval [CI], 1.18–4.37).

Other risk factors included a Charlson Comorbidity Index score of 1–2, being on platinum monochemotherapy and performance status.

More than half (57.2 percent) of the patients had died by the study’s end, with 1,203 deaths attributable to cancer. The median survival was 45.3 months. Major (hazard ratio [HR], 3.15, 95 percent CI, 1.59–6.22) and extensive (HR, 5.43, 95 percent CI, 2.34–12.6) PP significantly raised mortality risk 0–6 months after diagnosis.

From 6–12 months after diagnosis, having 1–2 (HR, 1.50, 95 percent CI, 1.06–2.11) and ≥3 (HR, 2.38, 95 percent CI, 1.25–4.50) PIMs emerged as significant risk factors for death.