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International Society of Geriatric Oncology Chemotherapy Taskforce: Evaluation of Chemotherapy in Older Patients—An Analysis of the Medical Literature

Stuart M. Lichtman, Hans Wildiers, Etienne Chatelut, Christopher Steer, Daniel Budman, Vicki A. Morrison, Brigitte Tranchand, Iuliana Shapira, Matti Aapro

From the Memorial Sloan-Kettering Cancer Center, New York; North Shore-Long Island Jewish Health System, Manhasset, NY; University of Minnesota, Minneapolis-St Paul, MN; University Hospital Gasthuisberg, Leuven, Belgium; Institut Claudius Regaud, Toulouse; Faculte Médecine Lyon-Sud, and centre Léon-Bérard, Lyon, France; Murray Valley Private Hospital, Wodonga, Victoria, Australia; Multidisciplinary Oncology Institute, Genolier, Switzerland

Address reprint requests to Stuart M. Lichtman, MD, Memorial Sloan-Kettering Cancer Center, 650 Commack Rd, Commack, NY 11725; e-mail: lichtmas{at}mskcc.org

The elderly comprise the majority of patients with cancer and are the recipients of the greatest amount of chemotherapy. Unfortunately, there is a lack of data to make evidence-based decisions with regard to chemotherapy. This is due to the minimal participation of older patients in clinical trials and that trials have not systematically evaluated chemotherapy. This article reviews the available information with regard to chemotherapy and aging provided by a task force of the International Society of Geriatric Oncology (SIOG). Due to the lack of prospective data, the conclusions and recommendations made are a consensus of the participants. Extrapolation of data from younger to older patients is necessary, particularly to those patients older than 80 years, for which data is almost entirely lacking. The classes of drugs reviewed include alkylators, antimetabolites, anthracyclines, taxanes, camptothecins, and epipodophyllotoxins. Clinical trials need to incorporate an analysis of chemotherapy in terms of the pharmacokinetic and pharmacodynamic effects of aging. In addition, data already accumulated need to be reanalyzed by age to aid in the management of the older cancer patient.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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