Chemotherapy in the Elderly: Pharmacologic Considerations
Chemotherapy in the Elderly: Pharmacologic Considerations
Background: The aging of the population has focused interest on the care of elderly cancer patients. A better understanding of the effects of chemotherapeutic agents on older patients with cancer will help to determine the appropriate use of chemotherapy for this age group.
Methods: The authors review recent studies and present pharmacokinetic data on several chemotherapeutic agents, particularly those that have recently become available.
Results: Agents such as gemcitabine, vinorelbine, the taxanes, anthracyclines, platinum compounds, topoisomerase I and II inhibitors, and the oral fluoropyrimidines appear to have a beneficial therapeutic index in elderly patients.
Conclusions: Careful attention to the physiologic changes associated with aging, along with dose adjustments for end-organ dysfunction (eg, renal and hepatic), is necessary to ensure the safe administration of antitumor chemotherapy to the elderly.
The fastest-growing segment of the US population is composed of persons who are 65 years of age or older. By 2030, an estimated 20.1% of the population will be 65 years of age or older. In the same period, the number of people 75 years of age or older will have tripled, and the 85-years-or-older age group will have doubled. Thus, physicians need to become familiar with the data regarding the treatment of older patients. The definition of older or elderly is somewhat arbitrary. Statistics are often based on Medicare information, thus dividing populations into groups of above and below 65 years of age. For study purposes, many studies further categorize patients as above 75 years of age.
This review focuses on the recent developments in the pharmacology of anticancer drugs in the elderly. As some common chemotherapy-related toxicities, eg, myelotoxicity, mucositis, and diarrhea, seem to be more prevalent and severe in the older patient population, this focus is particularly important.
Background: The aging of the population has focused interest on the care of elderly cancer patients. A better understanding of the effects of chemotherapeutic agents on older patients with cancer will help to determine the appropriate use of chemotherapy for this age group.
Methods: The authors review recent studies and present pharmacokinetic data on several chemotherapeutic agents, particularly those that have recently become available.
Results: Agents such as gemcitabine, vinorelbine, the taxanes, anthracyclines, platinum compounds, topoisomerase I and II inhibitors, and the oral fluoropyrimidines appear to have a beneficial therapeutic index in elderly patients.
Conclusions: Careful attention to the physiologic changes associated with aging, along with dose adjustments for end-organ dysfunction (eg, renal and hepatic), is necessary to ensure the safe administration of antitumor chemotherapy to the elderly.
The fastest-growing segment of the US population is composed of persons who are 65 years of age or older. By 2030, an estimated 20.1% of the population will be 65 years of age or older. In the same period, the number of people 75 years of age or older will have tripled, and the 85-years-or-older age group will have doubled. Thus, physicians need to become familiar with the data regarding the treatment of older patients. The definition of older or elderly is somewhat arbitrary. Statistics are often based on Medicare information, thus dividing populations into groups of above and below 65 years of age. For study purposes, many studies further categorize patients as above 75 years of age.
This review focuses on the recent developments in the pharmacology of anticancer drugs in the elderly. As some common chemotherapy-related toxicities, eg, myelotoxicity, mucositis, and diarrhea, seem to be more prevalent and severe in the older patient population, this focus is particularly important.
