BOSTONThe elderly may suffer more from the side effects of
chemotherapy, but toxicity should not necessarily prevent them from receiving
life-saving or palliative treatment, according to two speakers at the 14th
international meeting of the Multinational Association for Supportive Care in
Cancer (MASCC) and International Association for Oral Oncology.
Matti S. Aapro, MD, of the Institut Multidisciplinaire d’Oncologie,
Genolier, Switzerland, urged greater use of supportive careincluding
prophylactic use of agents such as filgrastim (Neupogen); pegfilgrastim (Neulasta);
epoetin alfa (Epogen, Procrit); and darbepoetin alfa (Aranesp)to ensure that
elderly patients can complete chemotherapy cycles on schedule. "Existing
means of supportive care should allow adequate chemotherapy use in almost
every person who may need this approach for cure or efficacious palliation of
cancer," he said.
Carsten Bokemeyer, MD, of Tuebin-gen University Hospital, Germany,
recommended sequential single-agent therapies for most elderly patients until
clinical trials prove combination therapies to be superior for this
population. Each combination therapy has to be considered separately, he
said, cautioning that in many cases they have not been proven more beneficial
than single-agent therapies for patients, regardless of age.
Both Drs. Aapro and Bokemeyer complained of a lack of data on toxicity in
the elderly. "Most new trials have excluded elderly patients," Dr. Bokemeyer
said. Oncologists considering combination treatments often find "no clear
correlation of dose intensity and toxicity and age," he said.
Dr. Aapro reported that a literature review found patients over the age of
70 had a significantly higher incidence of grade 3-4 neutropenia, neutropenic
infections, anemia, and thrombocytopenia when given CHOP-like regimens. In
nine studies of elderly patients given chemotherapy for non-Hodgkin’s lymphoma,
the risk of life-threatening neutropenia was greater than 40%, he said, while
the risk of associated infections ranged from 21% to 47%.
Similarly, he said, when given CMF (cyclophosphamide, methotrexate,
fluorouracil), breast cancer patients above the age of 65 have more than
twice as much grade 3 hematologic toxicity as younger patients: 9.2% vs 4.5%.
He cited myelosuppression as the most common chemotherapy-induced toxicity
and said depleted hematologic stem cell reserves and/or chronic disease is
the most common complicating factor in elderly patients.