General Aspects of Cancer Chemotherapy in the Aged
Age is one of the most important prognostic factors affecting outcome in the treatment of patients with neoplastic diseases. The negative impact of age is almost uniformly encountered with any solid tumor or hematologic malignancy. Detailed analysis of the negative implications of age on therapeutic outcome uncover tumorrelated factors, host-related factors and some degree of the interaction between tumor and host-related factors. For example, it is generally accepted that histologic or cytologie subtype of Hodgkin’s Disease or the acute leukemias have an important effect on outcome. The general observation is that the prognosis for Hodgkin’s Disease is worse on older i.e. > 60 years of age compared to younger patients i.e. in the 20–30 year age group. However, it is not the diagnosis of Hodgkin’s Disease per se that has a poorer prognosis in elderly patients but rather the impact of a more aggressive variant of Hodgkin’s Disease (lymphocyte depleted) which has a higher frequency of occurrence in elderly patients compared to younger patients. Likewise, the frequency and duration of response as well as curability of ALL1 in elderly patients is much lower than that possible in children. Reasons for this lesser effect include the fact that elderly patients with ALL have not only a higher frequency of biphenotypic ALL but also a higher frequency of Philadelphia chromosome positive ALL, both of which have negative prognostic implications in any age group. Older patients with AML1 more commonly have a history of antecedent myelodysplasias or secondary leukemias, historical features that have a negative prognostic impact in any age group.
KeywordsAnticancer Drug Anticancer Agent Dose Intensity Antineoplastic Agent Renal Plasma Flow
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