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(Drug information on filgrastim) (Neupogen); pegfilgrastim (Neulasta); epoetin alfa(Drug information on epoetin alfa) (Epogen, Procrit); and darbepoetin alfa(Drug information on 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(Drug information on methotrexate), fluorouracil(Drug information on 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.