Tolerability of Chemotherapy in Elderly Patients
European Association of NeuroOncology Magazine 2011; 1 (1): 21-24
Keywords: cancer, dose adjustment, neurology, oncology, renal function
In Western countries, prolonged life expectancies increase the importance of geriatric oncology. Consequently, the rationale for an aggressive procedure or best supportive care is a complex evaluation process which has to summarize the global situation of the old patient. While clinical cancer studies are designed on the basis of tumour type, staging, and other factors, factors such age, expected lifetime, performance status, and assessment of elderly patients are neglected. For instance, comorbidities > 75 years are found in almost 80 % for a single chronic disease, while ≥ 3 diagnoses are detectable in 1/3. Thus, it should be the primary aim to balance treatment, side effects, and potential benefits with reasonable therapeutic goals. While conventional chemotherapy was limited in elderly people by serious life-threatening side effects, novel individualized drug regimens may support compliance and improve therapeutic success. The introduction of novel targeted therapies currently roughens up the field of oncology. However, consequences of the new possible drug combinations in the light of side effects are pending. Particularly in elderly patients, the tolerability of these new concepts requires more evidencebased data, nevertheless, first data on adverse event comparisons are encouraging. The concept of a comprehensive geriatric assessment has been suggested to evaluate the multidimensional aspects of elderly cancer patients. Thus, profiling the personalized therapy may involve targeted anti-cancer therapy and adapted pharmacokinetics to ensure best clinical outcome. This review will summarize critical pharmacokinetic parameters which are important also in the general pharmacotherapy of elderly people.