Polypharmacy in Oncology

Published:September 13, 2022DOI:


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        • Halli-Tierney A.D.
        • Scarbrough C.
        • Carroll D.
        Polypharmacy: evaluating risks and deprescribing.
        Am Fam Physician. 2019; 100: 32-38
        • 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. 2021; 23: 65-73
        • Mohamed M.R.
        • Ramsdale E.
        • Loh K.P.
        • et al.
        Associations of polypharmacy and inappropriate medications with adverse outcomes in older adults with cancer: a systematic review and meta-analysis.
        Oncologist. 2020; 25: e94-e108
        • Calip G.S.
        • Xing S.
        • Jun D.H.
        • et al.
        Polypharmacy and adherence to adjuvant endocrine therapy for breast cancer.
        J Oncol Pract. 2017; 13: e451-e462
        • Farkas A.H.
        • Winn A.
        • Pezzin L.E.
        • et al.
        The use and concurrent use of side effect controlling medications among women on aromatase inhibitors.
        J Womens Health (Larchmt). 2021; 30: 131-136
        • Wyatt G.K.
        • Friedman L.L.
        • Given C.W.
        • et al.
        Complementary therapy use among older cancer patients.
        Cancer Pract. 1999; 7: 136-144
        • Topaloğlu U.S.
        • Özaslan E.
        Comorbidity and polypharmacy in patients with breast cancer.
        Breast Cancer. 2020; 27: 477-482
        • Lim H.S.
        • Ju Lee H.
        • Seok Lee K.
        • et al.
        Clinical implications of CYP2D6 genotypes predictive of tamoxifen pharmacokinetics in metastatic breast cancer.
        J Clin Oncol. 2007; 25: 3837-3845
        • Balducci L.
        • Goetz-Parten D.
        • Steinman M.A.
        Polypharmacy and the management of the older cancer patient.
        Ann Oncol. 2013; 24: vii36-vii40
        • Desmarais J.E.
        • Looper K.J.
        Interactions between tamoxifen and antidepressants via cytochrome P450 2D6.
        J Clin Psychiatry. 2009; 70: 1688-1697
        • Singh J.C.
        • Lichtman S.M.
        Effect of age on drug metabolism in women with breast cancer.
        Expert Opin Drug Metab Toxicol. 2015; 11: 757-766
        • Vyas A.M.
        • Kogut S.J.
        • Aroke H.
        Real-world direct health care costs associated with psychotropic polypharmacy among adults with common cancer types in the United States.
        J Manag Care Spec Pharm. 2019; 25: 555-565
        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2020.
        CA Cancer J Clin. 2020; 70: 7-30
        • Parikh S.A.
        • Shanafelt T.D.
        Prognostic factors and risk stratification in chronic lymphocytic leukemia.
        Semin Oncol. 2016; 43: 233-240
        • Burger J.A.
        • Tedeschi A.
        • Barr P.M.
        • et al.
        Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia.
        N Engl J Med. 2015; 373: 2425-2437
        • Estupiñán H.Y.
        • Berglöf A.
        • Zain R.
        • et al.
        Comparative analysis of BTK inhibitors and mechanisms underlying adverse effects.
        Front Cell Dev Biol. 2021; 9: 630942
        • Byrd J.C.
        • Hillmen P.
        • Ghia P.
        • et al.
        Acalabrutinib versus ibrutinib in previously treated chronic lymphocytic leukemia: results of the first randomized phase III trial.
        J Clin Oncol. 2021; 39: 3441-3452
        • Mock J.
        • Kunk P.R.
        • Palkimas S.
        • et al.
        Risk of major bleeding with ibrutinib.
        Clin Lymphoma Myeloma Leuk. 2018; 18: 755-761
        • Herishanu Y.
        • Avivi I.
        • Aharon A.
        • et al.
        Efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia.
        Blood. 2021; 137: 3165-3173
        • American Cancer Society
        Cancer facts & figures 2021.
        American Cancer Society, Atlanta2021
        • Maggiore R.J.
        • Dale W.
        • Gross C.P.
        • et al.
        Polypharmacy and potentially inappropriate medication use in older adults with cancer undergoing chemotherapy: effect on chemotherapy-related toxicity and hospitalization during treatment.
        J Am Geriatr Soc. 2014; 62: 1505-1512
        • Chen L.J.
        • Schöttker B.
        SIOG2021-0124 - association of polypharmacy with colorectal cancer survival among older patients.
        J Geriatr Oncol. 2021; 12: S59
        • Giampieri R.
        • Cantini L.
        • Giglio E.
        • et al.
        Impact of polypharmacy for chronic ailments in colon cancer patients: a review focused on drug repurposing.
        Cancers (Basel). 2020; 12: 2724
        • Mitrugno A.
        • Sylman J.L.
        • Ngo A.T.
        • et al.
        Aspirin therapy reduces the ability of platelets to promote colon and pancreatic cancer cell proliferation: implications for the oncoprotein c-MYC.
        Am J Physiol Cell Physiol. 2017; 312: C176-C189
        • Jiang W.
        • Yan Y.
        • Chen M.
        • et al.
        Aspirin enhances the sensitivity of colon cancer cells to cisplatin by abrogating the binding of NF-κB to the COX-2 promoter.
        Aging (Albany NY). 2020; 12: 611-627
        • Petrelli F.
        • Ghidini M.
        • Ghidini A.
        • et al.
        Use of antibiotics and risk of cancer: a systematic review and meta-analysis of observational studies.
        Cancers (Basel). 2019; 11: 1174
        • Abdel-Rahman O.
        • Ghosh S.
        • Walker J.
        Outcomes of metastatic colorectal cancer patients in relationship to prior and concurrent antibiotics use; individual patient data analysis of three clinical trials.
        Clin Transl Oncol. 2020; 22: 1651-1656
        • Stopper H.
        • Garcia S.B.
        • Waaga-Gasser A.M.
        • et al.
        Antidepressant fluoxetine and its potential against colon tumors.
        World J Gastrointest Oncol. 2014; 6: 11-21
        • Iskar M.
        • Bork P.
        • van Noort V.
        Discovery and validation of the antimetastatic activity of citalopram in colorectal cancer.
        Mol Cell Oncol. 2015; 2: e975080
        • Fang C.K.
        • Chen H.W.
        • Chiang I.T.
        • et al.
        Mirtazapine inhibits tumor growth via immune response and serotonergic system.
        PLoS One. 2012; 7: e38886
        • Chang C.H.
        • Lin J.W.
        • Wu L.C.
        • et al.
        Oral insulin secretagogues, insulin, and cancer risk in type 2 diabetes mellitus.
        J Clin Endocrinol Metab. 2012; 97: E1170-E1175
        • Pollak M.N.
        Investigating metformin for cancer prevention and treatment: the end of the beginning.
        Cancer Discov. 2012; 2: 778-790
        • Roberto M.
        • Rossi A.
        • Panebianco M.
        • et al.
        Drug-Drug interactions and pharmacogenomic evaluation in colorectal cancer patients: the new drug-PIN(®) system comprehensive approach.
        Pharmaceuticals (Basel). 2021; 14
      1. SEER cancer stat facts: lung and bronchus cancer. National Cancer Institute. Bethesda, MD.
        (Available at:) (Accessed January 24, 2022)
        • Panel
        American geriatrics society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults.
        J Am Geriatr Soc. 2019; 67: 674-694
        • Lund J.L.
        • Sanoff H.K.
        • Peacock Hinton S.
        • et al.
        Potential medication-related problems in older breast, colon, and lung cancer patients in the United States.
        Cancer Epidemiol Biomarkers Prev. 2018; 27: 41-49
        • Hakozaki T.
        • Hosomi Y.
        • Shimizu A.
        • et al.
        Polypharmacy as a prognostic factor in older patients with advanced non-small-cell lung cancer treated with anti-PD-1/PD-L1 antibody-based immunotherapy.
        J Cancer Res Clin Oncol. 2020; 146: 2659-2668
        • Kim M.J.
        • Duan Z.
        • Zhao H.
        • et al.
        Anti-dementia and anti-hyperlipidemic medication use at end of life in elderly lung cancer patients: analysis of SEER-Medicare data.
        J Clin Oncol. 2017; 35
        • Lu-Yao G.
        • Nightingale G.
        • Nikita N.
        • et al.
        Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy.
        J Geriatr Oncol. 2020; 11: 579-585
        • Panchal R.
        Systemic anticancer therapy (SACT) for lung cancer and its potential for interactions with other medicines.
        Ecancermedicalscience. 2017; 11: 764
        • Tsao M.-S.
        • Sakurada A.
        • Cutz J.-C.
        • et al.
        Erlotinib in lung cancer — molecular and clinical predictors of outcome.
        N Engl J Med. 2005; 353: 133-144
        • Soria J.-C.
        • Ohe Y.
        • Vansteenkiste J.
        • et al.
        Osimertinib in untreated EGFR-mutated advanced non–small-cell lung cancer.
        N Engl J Med. 2017; 378: 113-125
        • Budha N.R.
        • Frymoyer A.
        • Smelick G.S.
        • et al.
        Drug absorption interactions between oral targeted anticancer agents and PPIs: is pH-dependent solubility the Achilles heel of targeted therapy?.
        Clin Pharmacol Ther. 2012; 92: 203-213
        • Sharma M.
        • Holmes H.M.
        • Mehta H.B.
        • et al.
        The concomitant use of tyrosine kinase inhibitors and proton pump inhibitors: prevalence, predictors, and impact on survival and discontinuation of therapy in older adults with cancer.
        Cancer. 2019; 125: 1155-1162
        • American Cancer Society
        Facts & figures 2022.
        American Cancer Society, Atlanta, GA2022 (Accessed)
        • National Cancer Institute
        SEER cancer stat facts: prostate cancer.
        (Available at:) (Accessed February 15, 2022)
        • Tay K.J.
        • Moul J.W.
        • Armstrong A.J.
        Management of prostate cancer in the elderly.
        Clin Geriatr Med. 2016; 32: 113-132
        • Scosyrev E.
        • Messing E.M.
        • Mohile S.
        • et al.
        Prostate cancer in the elderly: frequency of advanced disease at presentation and disease-specific mortality.
        Cancer. 2012; 118: 3062-3070
        • Yu J.
        • Wang Y.
        • Ragueneau-Majlessi I.
        Pharmacokinetic drug-drug interactions with drugs approved by the us food and drug administration in 2020: mechanistic understanding and clinical recommendations.
        Drug Metab Dispos. 2022; 50: 1-7
      2. NCCN Clinical Practice Guidelines in Oncology – Prostate Cancer. Version 1.2022. Accessed.

        • Hebenstreit D.
        • Pichler R.
        • Heidegger I.
        Drug-drug interactions in prostate cancer treatment.
        Clin Genitourin Cancer. 2020; 18: e71-e82
        • Del Re M.
        • Fogli S.
        • Derosa L.
        • et al.
        The role of drug-drug interactions in prostate cancer treatment: focus on abiraterone acetate/prednisone and enzalutamide.
        Cancer Treat Rev. 2017; 55: 71-82
        • Vicente-Valor J.
        • Escudero-Vilaplana V.
        • Collado-Borrell R.
        • et al.
        Potential and real drug interactions in patients treated with abiraterone or enzalutamide in clinical practice.
        Expert Opin Drug Metab Toxicol. 2021; 17: 1467-1473
        • Zurth C.
        • Graudenz K.
        • Denner K.
        • et al.
        Drug-drug interaction (DDI) of darolutamide with cytochrome P450 (CYP) and P-glycoprotein (P-gp) substrates: results from clinical and in vitro studies.
        J Clin Oncol. 2019; 37: 297
        • Shore N.
        • Zurth C.
        • Fricke R.
        • et al.
        Evaluation of clinically relevant drug-drug interactions and population pharmacokinetics of darolutamide in patients with nonmetastatic castration-resistant prostate cancer: results of pre-specified and post hoc analyses of the phase III ARAMIS trial.
        Target Oncol. 2019; 14: 527-539