CANCER-CHEMOTHERAPY IN THE ELDERLY

As the geriatric population is growing, it is increasingly important t o be familiar with chemotherapy for the elderly. Age-related changes i n pharmacokinetics are documented for doxorubicin, etoposide, ifosfami de, daunorubicin, mitomycin, cisplatin and methotrexate, The hematolog ical toxicity of most standard-dose chemotherapy is not affected by ag e in patients with normal organic functions and good performance statu s, although increased toxicity with aging is suggested in the use of a ctinomycin-D, etoposide, vinblastin, methotrexate, methyl-CCNU, doxoru bicin and mitomycin, and in dose-intensive chemotherapy. Among non-hem atological toxicities, only doxorubicin-induced cardiomyopathy and ble omycin-induced pulmonary toxicity are demonstrated to be accelerated i n the elderly, There is no evidence that advanced age decreases the ef ficacy of chemotherapy for tumors, except for Hodgkin's disease and ac ute leukemia. These results suggest that advanced chronological age al one is not always associated with severe toxicity and poor prognosis, and that many elderly patients with cancer will benefit from chemother apy. To answer questions regarding the optimal chemotherapy regimen, d ose and intensity in this population, the influence of age should be a nalyzed in a multivariate approach in future studies.