Non-steroidal anti-inflammatory drugs induce severe hematologic toxicities in lung cancer patients receiving pemetrexed plus carboplatin: A retrospective cohort study.
OBJECTIVE
As the major toxicity induced by pemetrexed plus carboplatin is severe hematologic toxicities, the aim of this study was to determine the risk factors for severe hematologic toxicities in lung cancer patients.


METHODS
We retrospectively investigated data from lung cancer patients who had received pemetrexed plus carboplatin, with or without bevacizumab. This observational study was carried out at Ehime University Hospital using electronic medical records dating from July 2009 to March 2015. Severe hematologic toxicities were defined as grade 3 or 4, according to the Common Terminology Criteria for Adverse Events, version 4.0.


RESULTS
Forty-two patients were included in the study. The incidence of grade 3 or 4 hematologic toxicities during the first cycle of chemotherapy and during all cycles was 19.0% and 16.1%, respectively. Multivariate time-depend generalized estimating equations logistic regression analysis revealed that regular use of non-steroidal anti-inflammatory drugs (NSAIDs) was significantly associated with an increased risk of severe hematologic toxicities during all cycles (adjusted odds ratio (OR): 8.32, 95% confidence interval (CI): 1.27-54.38; p = 0.03), whereas creatinine clearance of <45 mL/min was not significantly associated with an increased risk of severe hematologic toxicities during all cycles (adjusted OR: 0.91, 95% CI: 0.25-3.34; p = 0.88).


CONCLUSIONS
The results suggest that severe hematologic toxicities in patients receiving carboplatin-based pemetrexed may be significantly induced by the inhibition of renal tubular pemetrexed secretion through drug-drug interactions between NSAIDs and pemetrexed rather than through glomerular filtration of pemetrexed, even with moderate to sufficient renal function.
Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan.
Hitoshi
H
Kawazoe
Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan.
Akiko
A
Yano
Division of Pharmacy, Komazawa Hospital, Setagaya-ku, Tokyo, Japan.
Yuri
Y
Ishida
Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan.
Kenshi
K
Takechi
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Hitoshi
H
Katayama
Department of Respiratory Medicine, National Hospital Organization Ehime Medical Center, Toon, Ehime, Japan.
Ryoji
R
Ito
Cancer Center, Ehime University Hospital, Toon, Ehime, Japan.
Yoshihiro
Y
Yakushijin
Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan.
Toshihide
T
Moriguchi
Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan.
Mamoru
M
Tanaka
Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan.
Akihiro
A
Tanaka
Division of Pharmacy, Ehime University Hospital, Toon, Ehime, Japan.
Hiroaki
H
Araki
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000139:chemically induced / Q000473:pathology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016190:Carboplatin / Q000627:therapeutic use*; D005260:Female; D006402:Hematologic Diseases / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007970:Leukopenia / Q000097:blood / Q000139:chemically induced / Q000473:pathology; D008175:Lung Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced / Q000473:pathology; D000068437:Pemetrexed / Q000627:therapeutic use*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced / Q000473:pathology; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000068437:Pemetrexed; D016190:Carboplatin