Impact of concomitant medication on recurrence, survival and tolerability of chemotherapy in early colon cancer patients – A post-hoc analysis of the PETACC 8 trial

IF 7.1 1区医学 Q1 ONCOLOGY

European Journal of Cancer Pub Date : 2025-07-12 DOI:10.1016/j.ejca.2025.115643

Elisabeth Sophie Bergen , Clémence Canton , Mathieu Boulin , Karine Le Malicot , Jaafar Bennouna , Daniel Gonzalez , Laurent Mineur , Olivier Bouche , Côme Lepage , Julien Taieb

{"title":"Impact of concomitant medication on recurrence, survival and tolerability of chemotherapy in early colon cancer patients – A post-hoc analysis of the PETACC 8 trial","authors":"Elisabeth Sophie Bergen , Clémence Canton , Mathieu Boulin , Karine Le Malicot , Jaafar Bennouna , Daniel Gonzalez , Laurent Mineur , Olivier Bouche , Côme Lepage , Julien Taieb","doi":"10.1016/j.ejca.2025.115643","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Only few information is available about the impact of concomitant medication (CM) and comorbidities on the outcome of cancer patients and the tolerability of chemotherapy.</div></div><div><h3>Methods</h3><div>Patients of the phase III randomized trial PETACC8 had resection with curative intent of a stage III colon cancer (CC) and were treated with standard adjuvant fluoropyrimidine and oxaliplatin + /- cetuximab over 6 months. Information on CM intake has been gathered by study visits at inclusion as well as during chemotherapy. We investigated the association between number of CM as well as the 5 most frequently applied CM categories according to the WHO ATC classification system (gastro-esophageal reflux disease (GERD) treatment, anticoagulants, platelet aggregation inhibitors, cardiovascular and antidiabetic drugs) with outcome and tolerability.</div></div><div><h3>Results</h3><div>Among 2559 patients, median number of CM intake was 8 (range 0–25), with only 22 patients (0.9 %) without any CM intake. Anticoagulation treatment was the only CM category being significantly and independently associated with a shorter disease-free survival (DFS) (HR 1.29, 95 %CI 1.06–1.56, <em>p = 0.010</em>) as well as overall survival (OS) (HR 1.28, 95 %CI 1.02–1.59, <em>p = 0.032</em>). No association of number of CM (<5,5–10,>10) has been observed neither with DFS (ref.;HR 0.98;HR 1.17) nor OS (ref.;HR 0.98;HR 1.15) (<em>p > 0.05</em>). Patients with anticoagulants experienced significantly more grade 3/4 adverse events (AEs) (75.9 % vs 64.8 %, <em>p = 0.002</em>) and treatment discontinuations due to toxicity (17.7 % vs 10.8 %, <em>p = 0.005</em>) compared to patients without anticoagulants.</div></div><div><h3>Discussion</h3><div>Early CC patients with polypharmacy do not generally exhibit an impaired outcome. Anticoagulation was the only CM category associated with a shorter DFS and OS which might be a consequence of enhanced toxicities necessitating treatment adaptations in these patients.</div></div>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"227 ","pages":"Article 115643"},"PeriodicalIF":7.1000,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Cancer","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0959804925004253","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Only few information is available about the impact of concomitant medication (CM) and comorbidities on the outcome of cancer patients and the tolerability of chemotherapy.

Methods

Patients of the phase III randomized trial PETACC8 had resection with curative intent of a stage III colon cancer (CC) and were treated with standard adjuvant fluoropyrimidine and oxaliplatin + /- cetuximab over 6 months. Information on CM intake has been gathered by study visits at inclusion as well as during chemotherapy. We investigated the association between number of CM as well as the 5 most frequently applied CM categories according to the WHO ATC classification system (gastro-esophageal reflux disease (GERD) treatment, anticoagulants, platelet aggregation inhibitors, cardiovascular and antidiabetic drugs) with outcome and tolerability.

Results

Among 2559 patients, median number of CM intake was 8 (range 0–25), with only 22 patients (0.9 %) without any CM intake. Anticoagulation treatment was the only CM category being significantly and independently associated with a shorter disease-free survival (DFS) (HR 1.29, 95 %CI 1.06–1.56, p = 0.010) as well as overall survival (OS) (HR 1.28, 95 %CI 1.02–1.59, p = 0.032). No association of number of CM (<5,5–10,>10) has been observed neither with DFS (ref.;HR 0.98;HR 1.17) nor OS (ref.;HR 0.98;HR 1.15) (p > 0.05). Patients with anticoagulants experienced significantly more grade 3/4 adverse events (AEs) (75.9 % vs 64.8 %, p = 0.002) and treatment discontinuations due to toxicity (17.7 % vs 10.8 %, p = 0.005) compared to patients without anticoagulants.

Discussion

Early CC patients with polypharmacy do not generally exhibit an impaired outcome. Anticoagulation was the only CM category associated with a shorter DFS and OS which might be a consequence of enhanced toxicities necessitating treatment adaptations in these patients.

查看原文本刊更多论文

联合用药对早期结肠癌患者化疗复发、生存和耐受性的影响——PETACC 8试验的事后分析

关于伴随用药（CM）和合并症对癌症患者预后和化疗耐受性的影响的信息很少。方法III期随机试验PETACC8的患者进行了III期结肠癌（CC）切除术，并接受标准辅助氟嘧啶和奥沙利铂+ /-西妥昔单抗治疗6个月。关于CM摄入的信息是在纳入研究时和化疗期间通过研究访问收集的。我们调查了CM的数量以及根据WHO ATC分类系统（胃食管反流病（GERD）治疗、抗凝剂、血小板聚集抑制剂、心血管和降糖药物）最常用的5种CM类别与预后和耐受性之间的关系。结果2559例患者中，摄入CM的中位数为8例（范围0 ~ 25例），未摄入CM的患者仅有22例（0.9% %）。抗凝治疗是唯一与较短的无病生存期（DFS）（HR 1.29, 95 %CI 1.06-1.56, p = 0.010）和总生存期（OS）（HR 1.28, 95 %CI 1.02-1.59, p = 0.032）显著独立相关的CM类别。CM数（<5,5 - 10,>10）与DFS （ref.;HR 0.98;HR 1.17）和OS （ref.;HR 0.98;HR 1.15）均无关联（p >； 0.05）。与未使用抗凝药物的患者相比，使用抗凝药物的患者明显经历了更多的3/4级不良事件（ae）（75.9 % vs 64.8 %,p = 0.002）和因毒性而中断治疗（17.7 % vs 10.8 %,p = 0.005）。早期多药CC患者通常不会表现出预后受损。抗凝是唯一与较短的DFS和OS相关的CM类别，这可能是这些患者需要适应治疗的毒性增强的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Cancer 医学-肿瘤学

CiteScore

11.50

自引率

4.80%

发文量

953

审稿时长

23 days

期刊介绍： The European Journal of Cancer (EJC) serves as a comprehensive platform integrating preclinical, digital, translational, and clinical research across the spectrum of cancer. From epidemiology, carcinogenesis, and biology to groundbreaking innovations in cancer treatment and patient care, the journal covers a wide array of topics. We publish original research, reviews, previews, editorial comments, and correspondence, fostering dialogue and advancement in the fight against cancer. Join us in our mission to drive progress and improve outcomes in cancer research and patient care.