Management of the toxicity of chemotherapy and targeted therapies in elderly cancer patients

Feliú, Jaime; Heredia-Soto, Victoria; Gironés, Regina; Jiménez-Munárriz, Beatriz; Saldaña, Juana; Guillén‐Ponce, Carmen; Molina‐Garrido, María‐José

doi:10.1007/s12094-019-02167-y

Cited by 38 publications

(36 citation statements)

References 89 publications

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“…The most important risk factor is the development of severe neutropenia; moreover the treatment, is older age (> 65 years). The use of colony-stimulating factors (G-CSF) in the elderly patients is recommended [39].…”

Section: Treatment Of Fragile and Elderly Patientsmentioning

confidence: 99%

SEOM clinical guidelines for the treatment of small-cell lung cancer (SCLC) (2019)

et al. 2020

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Small-cell lung cancer (SCLC) accounts for 15% of lung cancers. Only one-third of patients are diagnosed at limited stage. The median survival remains to be around 15-20 months without significative changes in the strategies of treatment for many years. In stage I and IIA, the standard treatment is the surgery followed by adjuvant therapy with platinum-etoposide. In stage IIB-IIIC, the recommended treatment is early concurrent chemotherapy with platinum-etoposide plus thoracic radiotherapy followed by prophylactic cranial irradiation in patients without progression. However, in the extensive stage, significant advances have been observed adding immunotherapy to platinum-etoposide chemotherapy to obtain a significant increase in overall survival, constituting the new recommended standard of care. In the second-line treatment, topotecan remains as the standard treatment. Reinduction with platinum-etoposide is the recommended regimen in patients with sensitive relapse (≥ 3 months) and new drugs such as lurbinectedin and immunotherapy are new treatment options. New biomarkers and new clinical trials designed according to the new classification of SCLC subtypes defined by distinct gene expression profiles are necessary.

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Section: Treatment Of Fragile and Elderly Patientsmentioning

confidence: 99%

SEOM clinical guidelines for the treatment of small-cell lung cancer (SCLC) (2019)

et al. 2020

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“…The elderly patient is a very heterogeneous patient type in relation to their general health state, degree of dependence, comorbidities, performance status, physical reserve, and geriatric situation [12]. Elderly patients with R/M HNSCC are at increased risk of adverse outcomes during and after treatment of head and neck cancer [4].…”

Section: Discussionmentioning

confidence: 99%

Tegafur-Uracil versus 5-Fluorouracil in Combination with Cisplatin and Cetuximab in Elderly Patients with Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Propensity Score Matching Analysis

Hsieh

Wang

Yang

et al. 2021

Biology

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There are increasing incidences of elderly patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, the treatment is not yet established. We conducted a propensity score matching analysis to evaluate the efficacy and safety of tegafur–uracil versus 5-fluorouracil in combination with cisplatin plus cetuximab in elderly patients with R/M HNSCC. Elderly patients with R/M HNSCC treated with cetuximab-containing chemotherapy were recruited into this study. In order to reduce the selection bias, propensity score matching was performed. Kaplan–Meier curves were plotted for progression-free survival (PFS) and overall survival (OS). Toxicities were graded according to the National Cancer Institute’s Common Terminology Criteria V3.0. After propensity sore matching, 54 patients with tegafur–uracil, cisplatin plus cetuximab (UPEx), and 54 patients with 5-fluorouracil, cisplatin plus cetuximab (EXTREME) were identified. The median PFS was 5.4 months in UPEx and 5.8 months in EXTREME (p = 0.451). The median OS was 10.8 months in UPEx and 10.2 months in EXTREME (p = 0.807). The overall response rate (ORR) and disease control rate (DCR) were insignificant in both arms, accounting for 61% versus 59% (p = 0.680) and 72% versus 70% (p = 0.732) in the UPEx arm and the EXTREME arm, respectively. A multivariate analysis showed that age and ECOG PS were, independently, predictors. Grade 3/4 adverse events were much fewer in UPEx than in EXTREME (p < 0.001). Both cetuximab-containing chemotherapies are effective in elderly patients with R/M HNSCC. Safety profiles are improved when tegafur–uracil is substituted for 5-fluorouracil. Further prospective studies are warranted to validate our conclusions.

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“…As mentioned, literature data about the use of tyrosine kinase inhibitor (TKI) for the treatment of mRCC in elderly patients is scarce. study emphasized the fact that despite high cancer frequency in this population there is a lack of data as well as a fear of side effect and a minimization of potential benefit (5). Data come from clinical trials involving a selected population not representative of elderly population.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding metastatic disease, 20-30% of all RCC are metastatic (mRCC) at diagnosis while 20% of patients with initially localized RCC will encounter metastatic recurrence during follow-up. Specific data regarding the management of TT in elderly patients are scarce (5). Whereas they represent a particular population with an increased incidence of comorbidities as chronic kidney disease (CKD) or liver dysfunction, as well as polymedication.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of anti-vascular endothelial growth factor therapies in older patients for first line treatment of metastatic renal cell carcinoma

Dupuis¹,

Chebbi²,

Surlemont³

et al. 2021

Transl Androl Urol

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Background: immunotherapy became the first line treatment of metastatic renal cell carcinoma (mRCC).Nevertheless, a better understanding of the specificities of targeted therapies (TT) in the elderly population could be helpful in order to improve the management of mRCC in this population. The aim of this retrospective study was to assess efficacy and safety of sunitinib and sorafenib used as first-line TT in 70 years older patients compared to younger patients.Methods: Data were retrospectively collected for all consecutive mRCC patients receiving first line TT treatment by sunitinib or sorafenib for mRCC from January 2006 to November 2017. Patients were divided into two groups according to the age using a cut-off at 70 years old. Median progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method and compared using log-rank test.Results: In total, 147 patients were included; 94 (63.9%) were <70 and 53 (36.1%) were 70 years old or more. First line TT used was sunitinib in 123 (83.7%) patients or sorafenib in 24 (16.3%) patients. Median PFS was 8 months for elderly patients vs. 6 in younger group (P=0.68). Median OS were 26 vs. 36 months (P=0.08). Severe induced toxicity was more frequent among elderly patients: 34 (64.2%) vs. 46 patients (48.9%) (P=0.07). Rate of treatment discontinuation due to toxicity was 22 patients (23.4%) in younger group vs. 28 patients (52.8%) in the elderly group (P=0.0005). Results were similar in the 2 groups regarding the type of toxicities.Conclusions: Our results suggest similar efficacy of anti-vascular endothelial growth factor (VEGF) agents as first-line treatment for mRCC among younger and older patients with an age cut-off of 70 years. Safety results suggest that these drugs can be safely used for older patients with a need of caution regarding toxicity prevention.

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Management of the toxicity of chemotherapy and targeted therapies in elderly cancer patients

Cited by 38 publications

References 89 publications

SEOM clinical guidelines for the treatment of small-cell lung cancer (SCLC) (2019)

SEOM clinical guidelines for the treatment of small-cell lung cancer (SCLC) (2019)

Tegafur-Uracil versus 5-Fluorouracil in Combination with Cisplatin and Cetuximab in Elderly Patients with Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Propensity Score Matching Analysis

Efficacy and safety of anti-vascular endothelial growth factor therapies in older patients for first line treatment of metastatic renal cell carcinoma

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