From the Memorial Sloan-Kettering Cancer Center, Commack, NY
Author's disclosure of potential conflicts of interest is found at the end of this article.
Address reprint requests to Stuart M. Lichtman, MD, Memorial Sloan-Kettering Cancer Center, Commack, NY 11725; e-mail: lichtmas{at}mskcc.org
Overview: The exclusion of older patients from clinical trials has resulted in a lack of data, making it difficult to form evidence-based treatment decisions. The data that have been accumulated show that clinically significant age-related changes in chemotherapy are rare. Most differences are related to patient factors, such as comorbidity, particularly end-organ dysfunction, and physiologic changes with age.
There are essentially no data involving patients older than age 80. The clinician must continue to extrapolate data to fit the individual patient, and clinical judgment will always be important. The categories of chemotherapeutic drugs to be reviewed are the alkylating agents, fluoropyrimidines, methotrexate, anthracyclines, taxanes, oxaliplatin, and irinotecan. Biologic and targeted therapies also will be discussed.
