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Pharmaceutical Medicine

, Volume 33, Issue 1, pp 21–27 | Cite as

Adverse Drug Reactions Involving Protein Kinase Inhibitors: A French Pharmacovigilance Database Study Comparing Safety in Younger and Older Patients (≥ 75 years) with Cancer

  • Vincent Clapes
  • Vanessa Rousseau
  • Fabien Despas
  • Jean-Louis Montastruc
  • Pascale OlivierEmail author
Original Research Article

Abstract

Background

Despite the increasing incidence of cancers in elderly people, this population remains under-represented in clinical trials. As a result, data describing the safety and efficacy of protein kinase inhibitors (PKIs) specifically in older patients with cancer are lacking. Advanced age may have a significant impact on drug pharmacology, but data on PKI safety in older patients remain poorly described in “real life”.

Objectives

We performed an observational study describing adverse drug reactions (ADRs) related to PKIs and compared the results for younger and older (aged ≥ 75 years) patients.

Methods

We extracted all notifications considered to be related to PKIs from our regional pharmacovigilance database between March 2003 and November 2015. Information about patients, drug exposure, and ADRs were captured. After a descriptive analysis of ADRs, we compared their characteristics between older and younger patients.

Results

In total, 214 patients experienced 320 ADRs related to PKIs. Slightly over half the patients were male (57%). The mean age was 64.1 years (range 15–90), and 52 (24.3%) patients were aged ≥ 75 years. Cutaneous reactions were the most frequently reported ADRs (22.9%), followed by gastrointestinal (16.8%) and respiratory (12.1%) ADRs. The most often involved PKIs were imatinib [54 patients (25.2%)], dasatinib [25 (11.7%)], sunitinib [25 (11.7%)], erlotinib [25 (11.7%)], and sorafenib [24 (11.2%)], followed by vemurafenib [17 (7.9%)] and everolimus and nilotinib, with 11 patients (5.1%) each. These drugs were administered mostly for three therapeutic indications: chronic myeloid leukemia [56 patients (26.2%)], malignant urinary tract cancer [31 (14.5%)], and bronchial cancer [27 (12.6%)]. Comparison of PKI-related ADRs between older and younger patients showed no significant difference, except for the mean number of coadministered drugs (5.3 vs. 4.2; p = 0.03) and the proportion of vascular ADRs (17.3 vs. 4.3%; p = 0.005), mainly arterial hypertension, which were both significantly more frequent in the older group.

Conclusions

Our work showed that PKI-related ADRs in older patients were similar to those in younger adults, except for vascular ADRs, which were significantly more frequent in the older population. Our results require confirmation by larger studies but could lead physicians to be more vigilant about cardiovascular comorbidities during initiation of PKIs in elderly people.

Notes

Acknowledgements

Part of this study was presented as a poster at the 2017 French Congress of Physiology, Pharmacology and Therapeutics (Rouen, 19–21 April 2017, Rouen, France).

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the conduct of this study or the preparation of this article.

Conflict of interest

Vincent Clapes, Vanessa Rousseau, Fabien Despas, Jean-Louis Montastruc, and Pascale Olivier have no conflicts of interest.

Ethical approval

This is a retrospective study using data already captured in a database; for this type of study no formal consent is required.

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Service de Pharmacologie Médicale et Clinique, Centre de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le MédicamentCentre Hospitalier Universitaire et Faculté de Médecine de ToulouseToulouseFrance
  2. 2.Faculté de Médecine, INSERM, UMR 1027, CIC INSERM 1436Université de ToulouseToulouseFrance

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