The influence of comorbidity and comedication on grade III/IV toxicity and prior discontinuation of chemotherapy in recurrent ovarian cancer patients: An individual participant data meta-analysis of the North-Eastern German Society of Gynecological Oncolo

• Cardiovascular disease is associated with hematological and non-hematological grade III/IV toxicities.
• ACE-inhibitors and diuretics highly influence renal toxicity in recurrent ovarian cancer patients.
• No comorbidity was associated with prior discontinuation of chemotherapy.

BackgroundOvarian cancer is usually a cancer of the older age group. Comorbidities and comedications increase with rising age. Aim of this study was to evaluate association of comorbidity and comedication with grade III/IV toxicities and prior cessation of chemotherapy in ovarian cancer patients.Patients and methodsAs an individual participant data meta-analysis this study analyzes the original data of three phase II/III chemotherapy studies of the North-Eastern German Society of Gynecological Oncology (NOGGO). Risk scores for certain combinations of risk factors were calculated based on stepwise regression analyses.ResultsAltogether, 1213 patients were included in the study. Cardiovascular disease was the most frequent comorbidity (47.5%). In multivariate analyses it was associated with hematological, non-hematological, pulmonary and renal grade III/IV toxicities (p = 0.002; p < 0.001; p = 0.005; p < 0.001). Renal toxicity was more frequent when using diuretics and ACE-inhibitors (p < 0.001; p = 0.002). Prior cessation of therapy was e.g. associated with use of diuretics, insulin and digitalis (p = 0.001; p = 0.04; p = 0.03). The risk for renal grade III/IV toxicities was more than 16 times higher when using both a diuretic and an ACE-inhibitor.ConclusionsRegimens of ovarian cancer treatment should not be restricted to direct cancer therapy but rather include additional individualized treatment of comorbidities. Comedications such as diuretics increase grade III/IV toxicities and patients at risk should be closely monitored.