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. 2017 Feb 3;12(2):e0171066.
doi: 10.1371/journal.pone.0171066. eCollection 2017.

Non-steroidal anti-inflammatory drugs induce severe hematologic toxicities in lung cancer patients receiving pemetrexed plus carboplatin: A retrospective cohort study

Hitoshi Kawazoe  1 , Akiko Yano  1 , Yuri Ishida  2 , Kenshi Takechi  1 , Hitoshi Katayama  3 , Ryoji Ito  4 , Yoshihiro Yakushijin  5 , Toshihide Moriguchi  1 , Mamoru Tanaka  1 , Akihiro Tanaka  1 , Hiroaki Araki  1
Affiliations

Non-steroidal anti-inflammatory drugs induce severe hematologic toxicities in lung cancer patients receiving pemetrexed plus carboplatin: A retrospective cohort study

Hitoshi Kawazoe et al. PLoS One. .

Abstract

Purpose: 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Forest plot of univariate time-depend GEE logistic regression analysis for risk factors associated with severe hematologic toxicities.
OR odds ratio, CI confidence interval, RDI relative dose intensity, AUC targeted area under the curve estimated by the Calvert formula, NSAIDs non-steroidal anti-inflammatory drugs, ACE angiotensin-converting enzyme inhibitor, ARB angiotensin receptor blocker, PPIs proton pump inhibitors, ZOL zoledronic acid, HGB hemoglobin, CCr creatinine clearance. Univariate time-depend GEE logistic regression analysis was used to identify the risk factors associated with severe hematologic toxicities per cycle. *p < 0.05.
Fig 2
Fig 2. Forest plot of multivariate time-depend GEE logistic regression analysis for risk factors associated with severe hematologic toxicities.
Multivariate time-depend GEE logistic regression analysis was used to identify the risk factors associated with severe hematologic toxicities per cycle. *p < 0.05.
See this image and copyright information in PMC

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