title: Patients with advanced lung cancer: is there scope to discontinue inappropriate medication?
abstract: BACKGROUND
  Polypharmacy-taking five or medications per day-is common in lung cancer patients. This patient group is prescribed medication to control acute symptoms associated with cancer and also to prevent or treat other long-term conditions. These medications increase the pill burden for the patient and also the probability of developing a drug-related toxicity.
  
  
  OBJECTIVE
  To assess the prevalence of inappropriate medication in patients taking erlotinib for the treatment of advanced non-small cell lung cancer.
  
  
  METHODS
  This was a multicentre study across three sites in the North of England. Medication histories for patients receiving erlotinib were retrospectively extracted from medical notes and assessed by the clinical team (a consultant pharmacist, nurse specialist and clinical oncologist) to determine if the medication was appropriate or inappropriate. The clinical team considered the following factors when deciding if the medication was appropriate or inappropriate: remaining life expectancy of the patient, time until benefit of the treatment, goals of care and treatment targets.
  
  
  RESULTS
  Among the 20 patients assessed, 19 (95 %) according to the clinical team were taking medications that were inappropriate. The mean number of medications the patients were taking was 8 (range 1-16) and the most common class of medication used were drugs affecting the Central Nervous System. In addition, there were 11 patients (55 %) who were taking erlotinib in combination with a proton pump inhibitor (PPI)-a clinically significant drug interaction that impairs the absorption of erlotinib.
  
  
  CONCLUSIONS
  Patients taking erlotinib for the treatment of advanced non-small cell lung cancer take many inappropriate medications for the treatment or prevention of long-term conditions. These patients should have their medications reviewed in the context of their original therapeutic goals.
authors.affiliation: Department of Pharmacy, Health and Well-being, Faculty of Applied Sciences, University of Sunderland, Wharncliffe Street, Sunderland, SR1 3SD, UK. adam.todd@durham.ac.uk
authors.forename: Adam
authors.initials: A
authors.lastname: Todd
authors.forename: Steve
authors.initials: S
authors.lastname: Williamson
authors.forename: Andy
authors.initials: A
authors.lastname: Husband
authors.forename: Wasim
authors.initials: W
authors.lastname: Baqir
authors.forename: Mairead
authors.initials: M
authors.lastname: Mahony
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D004347:Drug Interactions; D004739:England; D000069347:Erlotinib Hydrochloride; D006801:Humans; D057970:Inappropriate Prescribing; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019338:Polypharmacy; D015995:Prevalence; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000494:pharmacology; D011799:Quinazolines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D054328:Proton Pump Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride