|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 3 | Page : 583-584
Polypharmacy in the elderly on immunotherapy: Problem or opportunity?
National Oncology Center, The Royal Hospital, Muscat, Sultanate of Oman
|Date of Submission||10-Aug-2021|
|Date of Decision||21-Aug-2021|
|Date of Acceptance||07-Sep-2021|
|Date of Web Publication||08-Oct-2021|
National Oncology Center, The Royal Hospital, Muscat
Sultanate of Oman
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Venniyoor A. Polypharmacy in the elderly on immunotherapy: Problem or opportunity?. Cancer Res Stat Treat 2021;4:583-4
I read with interest the original article on the efficacy and safety outcomes of immune checkpoint inhibitors (ICIs) in the elderly in India by Abraham et al. and the thoughtful accompanying editorial. I agree with the authors that the outcomes are comparable to those reported from the Western world. I had raised some concerns earlier that these agents could precipitate more severe autoimmune reactions in our population and am glad to note that these apprehensions were misplaced. However, data from an apex institute staffed with oncologists of a higher level of skillsets cannot be taken as “real world” data and there should be an attempt to obtain evidence at the community level.
The authors mention that one of the problems with the elderly is polypharmacy leading to harmful drug interactions., Not surprisingly, at least one of every two patients in their data set had a comorbid condition. As an aside, it would be worth recording the prevalence of non-alcoholic fatty liver disease in this population in future as this condition has some unique interactions with ICIs. I feel that polypharmacy is an opportunity rather than a problem as some commonly used drugs in conditions such as hypertension and diabetes may actually potentiate the activity of ICIs. Long-term survival with the current generation of ICIs seems to have plateaued at <25% and there is keen interest in combining them with immune stimulant and anti-angiogenic drugs to augment their efficacy. Current evidence is confined to combinations with agents such as bevacizumab and tyrosine kinase inhibitors in cancers such as of liver and kidney; these needed extensive trials to ensure safety and are expensive. It is known that commonly used drugs such as metformin, propranolol, antiepileptics, antibiotics, and angiotensin-converting enzyme inhibitors have similar immune stimulant and anti-angiogenic properties. They have been in use for decades, come with known safety profiles, are cheaper, and will be easier to incorporate. Prospective trials in combination with ICIs are ongoing and results are awaited. Larger data sets that include details of non-oncological drugs used by patients on immunotherapy would contribute additional evidence towards repurposing of these drugs, and at significantly lower costs.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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