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The Use of Chemotherapy in Elderly Cancer Patients: Dose Adjusting, Drug Interactions, and Polypharmacy

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Management of Breast Cancer in Older Women

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Abstract

In geriatric oncology, the progressive decline of the functional reserve of multiple organ systems and restriction in personal and social resources represent the most important variables in treatment choice. As aging process is highly individualized, the key to safe and effective management of cancer in the older patient is individualization of treatment. The application of this model requires proper evaluation of the global health status of the older patient. The most reliable and best validated assessment is referred to as comprehensive geriatric assessment (CGA) (Repetto et al. 2002; Extermann et al. 2005).

Older patients are generally more susceptible to treatment-related toxicity due to reduced organ functional reserves, changes in the body composition, comorbidities, polypharmacy, nutritional status, and dehydration. All these conditions may affect the pharmacokinetic (PK) and the pharmacodynamic (PD) properties of administered drugs and require the exclusion of certain drugs or dose adjustment. For drugs with a high therapeutic index, dose adjusting may be clinically unimportant, but for cytotoxic drugs, pharmacological changes occurring with age may be responsible for severe toxicity.

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  1. Department of Oncology, INRCA-IRCCS, Rome, Italy

    Lazzaro Repetto & Claudia Di Bartolomeo

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  1. Lazzaro Repetto
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  2. Claudia Di Bartolomeo
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Correspondence to Lazzaro Repetto .

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  1. University of Sheffield, Sheffield, S10 2JF, United Kingdom

    Malcolm W. Reed

  2. Marshalls Cross Road, St Helens, WA9 3DA, United Kingdom

    Riccardo A. Audisio

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Repetto, L., Di Bartolomeo, C. (2010). The Use of Chemotherapy in Elderly Cancer Patients: Dose Adjusting, Drug Interactions, and Polypharmacy. In: Reed, M., Audisio, R. (eds) Management of Breast Cancer in Older Women. Springer, London. https://doi.org/10.1007/978-1-84800-265-4_20

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