ReviewFrontiers in pharmacology2025
Polypharmacy driven synergistic toxicities in elderly breast cancer chemotherapy drug management and adverse drug reactions: a mini review.
Review in Frontiers in pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Real-world treatment patterns and outcomes in older patients with metastatic breast cancer: a multi-institutional retrospective cohort study.Breast cancer research and treatment · 2026Article
- Active monitoring vs. spontaneous reporting of antineoplastic drug-related adverse drug reactions: evidence from the Chinese hospital pharmacovigilance system.Frontiers in health services · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Breast cancer is increasingly diagnosed in older women (median age ≈63 years), and chemotherapy outcomes are clouded by a polypharmacy landscape-defined here as ≥5 concurrent medications-that magnifies toxicity beyond single-agent expectations. Prospective geriatric-oncology cohorts reveal a median of eleven concomitant drugs and clinically relevant potential drug-drug interactions (rPDDI) in up to 75% of patients; each level-1 conflict almost doubles grade 3-4 non-haematological events, while polypharmacy-frailty indices outperform chronological age for predicting unplanned hospitalisation. Age-linked gastric alkalisation, cytochrome-P450 attrition and renal decline compress pharmacokinetic space: cimetidine lifts epirubicin exposure by 39%, proton-pump inhibitors halve palbociclib troughs yet heighten neutropenia, and triazole antifungals quadruple free vincristine levels, yielding neuropathy in 87% of recipients. Beyond kinetics, overlapping end-organ liabilities-anthracycline-trastuzumab cardiotoxicity, taxane-β-blocker arrhythmia, capecitabine-warfarin haemorrhage-translate polypharmacy into a synergistic toxicity premium that erodes functional independence. Pharmacist-led reconciliation coupled with algorithmic deprescribing removes ≥1 potentially inappropriate medication in 80% of elders, while electronic rPDDI alerting and DPYD/CYP2D6 genotyping halve severe events without sacrificing efficacy. Composite scores integrating regimen complexity with genomic risk and circulating toxicity markers are emerging as real-time sentinels. By weaving mechanistic, epidemiologic and implementation evidence, this review charts how polypharmacy propels synergistic toxicities in elderly breast-cancer chemotherapy and delineates stewardship frameworks poised to reconcile oncologic potency with geriatric safety.
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Registered trials
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