Toxicity profile, adverse drug reactions and drug-drug interactions among geriatric cancer patients under metronomic chemotherapy in a South Indian tertiary care hospital

Abstract

Objective The study aims to examine the toxicity profile, pattern of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in geriatric cancer patients receiving metronomic chemotherapy. Patients and Methods Patients were followed after each cycle till 12 weeks. Haematological parameters such as complete blood count, liver function test and renal function test were recorded from the baseline to the final visit. The Common Terminology Criteria for Adverse Events (CTCAE) scale was used to characterise the toxicity profile. ADRs that the patients had were documented and assessed for its causality, severity and preventability. The Lexicomp drug interaction checker was used to grade DDIs. Results Of 129 patients, according to CTCAE grading, haemoglobin indicated grade 1 toxicity, while other haematological parameters revealed no toxicity. Although there was a statistically significant difference in ALT, alkaline phosphate, serum creatinine and potassium ( p < 0.05), it was not clinically significant. A total of 226 ADRs were documented. Anaemia was the most frequently occurred ADR (14%) and Capecitabine caused the highest number of ADRs. Assessments of causality showed that the majority of cases are “possible” (63%). In evaluating the severity of ADRs, 99% ADRs were “mild” and 61% of ADRs were “probably” preventable. Upon assessing the DDIs, 82% of the prescriptions had “no known interaction”. Conclusion Metronomic chemotherapy in geriatric cancer patients exhibited grade 1 toxicity for haemoglobin. Anemia was the most common ADRs. The majority of cases were “possible” in causality, “mild” in severity, and “probably” preventable. The majority of the prescriptions have no known DDIs.

Implementation of pharmaceutical care service to elderly cancer patients in a tertiary care hospital in South India

“…The most common treatment-related ADRs in this study were nausea and vomiting, which is consistent with Chopra et al 27 However, in the study by Llopis-Salvia et al 29 the most common ADR was leukaemia, while in the study by Sharma et al 30 the most common ADR was body pain. In the current study, gastrointestinal system-related ADRs were the most common, similar to Alagizy et al, 31 whereas blood and lymphatic system-related ADRs were the most common in a study conducted by Sureshkumar et al 32…”

“…The most common treatment-related ADRs in this study were nausea and vomiting, which is consistent with Chopra et al 27 However, in the study by Llopis-Salvia et al 29 the most common ADR was leukaemia, while in the study by Sharma et al 30 the most common ADR was body pain. In the current study, gastrointestinal system-related ADRs were the most common, similar to Alagizy et al, 31 whereas blood and lymphatic system-related ADRs were the most common in a study conducted by Sureshkumar et al 32 More than two-thirds of ADRs were associated 'possibly' to suspected anti-cancer drugs in causality evaluation, mild in severity, and the majority of them were preventable, according to Sharma et al, 33 which is similar with the findings of this study. Identification and assessment of DRPs, providing education to the patient/care taker level regarding their drug therapy, duration, side effects, safety and precautions, and importance of adherence to the therapy enabled them to understand and adhere to the medication regimen effectively.…”

Studi Potong Lintang Peresepan Obat Pasien Geriatri di Puskesmas Tangerang: Tinjauan Interaksi Obat

“…Dalam salah satu penelitian dilaporkan bahwa pasien geriatri memiliki risiko mengalami efek samping obat yang tidak diinginkan 7 kali lebih sering daripada pasien dengan usia yang lebih muda pada pemberian obat dengan dosis biasa dan lebih sering menerima obat yang tidak tepat (9)(10)(11). Sebagai tambahan, dalam salah satu laporan kasus ditemukan bahwa pemberian tolvaptan dan warfarin secara bersamaan pada pasien geriatri berusia 92 tahun dapat bersifat sinergistik dalam menimbulkan infark serebral yang cukup luas secara klinis dan potensi interaksi obat keganasan ditemukan lebih tinggi pada pasien geriatri (12)(13)(14). Potensi interaksi obat yang selama ini hadir sebagai risiko dari pengobatan, tidak bisa diabaikan begitu saja mengingat potensi interaksi obat dapat timbul secara klinis bila tidak diantisipasi pada pasienpasien geriatri.…”