Clinical Pharmacology of Chemotherapy Agents in Older People with Cancer

Abstract

Populations around the world are aging, and the associated increase in cancer incidence has led to the recognition of the importance of geriatric oncology. Chronological age is a poor determinant of pharmacological response to cancer chemotherapy agents. Age-associated changes in physiology and organ function have a significant impact on the clinical pharmacology of cancer chemotherapy agents used in cancer treatment. Altered response to medicines in older people is a consequence of changes in body composition, organ function, concomitant pathophysiology, multiple medications, genetic determinants of drug response, and patient's clinical status. These issues highlight the need to individualize the management of cancer in the older people with consideration of age-related changes in the clinical pharmacology of cancer drugs, analgesics, and adjunctive therapies.

Potential Drug Interactions in Patients with a History of Cancer

“…With the changing demographics of an aging population, polypharmacy has become an increasingly pertinent issue in clinical practice [1][2][3][4][5][6] . In the literature, polypharmacy has been defined as the use of multiple drugs and of more drugs than clinically indicated.…”

“…In the literature, polypharmacy has been defined as the use of multiple drugs and of more drugs than clinically indicated. Despite the differences in definition, authors generally agree that the prevalence of polypharmacy has increased dramatically in recent decades and continues to increase [1][2][3][4][5][6] . Analyses of nationally representative surveys from the Swedish Panel Study of Living Conditions of the Oldest Old found that polypharmacy rates more than doubled to 46% in 2002 from 18% in 1992 6 .…”

“…Because the risk of drug interactions can vary significantly based on patient characteristics such as age 4,7,10 , sex 11 , and body composition 4 , and on medication characteristics such as the number and types of drugs being used 7,9,12,13 , pdis can be difficult to screen for and to detect, underscoring the need to develop ways of identifying high-risk individuals.…”

Clinical and Safety Profile of High-Dose Interleukin-2 Treatment in Elderly Patients with Metastatic Melanoma and Renal Cell Carcinoma

“…Because of these requirements, early clinical indications for IL-2 excluded elderly patients, particularly those >70 years of age. Although older patients may exhibit differences in pharmacodynamics of cancer therapeutics based on alterations in organ function, frequent use of concomitant medications and the presence of other medical disorders, there is increasing evidence that elderly patients may tolerate cancer therapy, including surgical oncology procedures, radiation therapy and chemotherapy, as well as younger patients [8,9,10]. To date, there are no publications on outcomes of older patients treated with high-dose IL-2.…”

Implementation of self-care symptom management program to enhance the quality of life of cancer patients undergoing chemotherapy and their family caregivers

“…In this context, it should be noted that physiological changes related to aging and comorbidity can also increase the risk of toxicity of chemotherapy. 20 The use of antiemetics and analgesics prescribed by the doctor, teaching the skills needed to manage side effects (e.g. better oral hygiene and the use of warm compresses), as well as providing information to eat small meals or drink warm ginger drinks when nauseous, could be useful in decreasing the severity of their symptoms for the majority of this study's participants.…”