Cancer in the elderly: why so badly treated?

Fentiman, Ian S.; Tirelli, Umberto; Monfardini, S.; Schneider, M.; Festen, J.; Cognetti, F.; Aapro, Matti

doi:10.1016/0140-6736(90)91075-l

Cited by 327 publications

(130 citation statements)

References 4 publications

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

“…Ironically, elderly patients are then eminently suitable candidates to evaluate new agents for CLL because they have usually received less previous treatment than younger patients. 1 Some newer anthracyclines and purine analogues seem to have a beneficial therapeutic index particularly for elderly patients. 14 There are other precedents to suggest that age is not a significant factor in cellular response to treatment.…”

Section: Figurementioning

confidence: 99%

“…Clinician belief that the elderly are poorly tolerant of chemotherapy or radiotherapy may result in the under-referral and under-treatment of many elderly patients. 1 Many physicians arbitrarily use single agents (as opposed to combination chemotherapy), decrease the dosage of chemotherapy, or even withhold cytotoxics for the elderly patient. Ironically, elderly patients are then eminently suitable candidates to evaluate new agents for CLL because they have usually received less previous treatment than younger patients.…”

Section: Figurementioning

confidence: 99%

“…Where this is not the case, it is debatable whether older patients should automatically be treated less aggressively that younger. 1 Almost without exception, the behaviour of common cancers is no more or less aggressive in older patients. 1 Studies have found a biological basis for a difference in response to chemotherapy with respect to age in ALL, 2 childhood ALL 3 and AML.…”

Section: Introductionmentioning

confidence: 99%

“…1 Almost without exception, the behaviour of common cancers is no more or less aggressive in older patients. 1 Studies have found a biological basis for a difference in response to chemotherapy with respect to age in ALL, 2 childhood ALL 3 and AML. 4 This raises the question of whether there is a similar biological basis to support age-related treatment schedules in CLL, which, unlike other malignancies, is genetically very stable.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ex vivo assessment of drug response by differential staining cytotoxicity (DiSC) assay suggests a biological basis for equality of chemotherapy irrespective of age for patients with chronic lymphocytic leukaemia

Bosanquet

2000

Leukemia

View full text Add to dashboard Cite

With a mean age at diagnosis for chronic lymphocytic leukaemia (CLL) of 65 years, development of optimal therapeutic regimens has been hampered by the advanced age of patients. In general, because of comorbidity older patients are not treated with the intent of achieving a complete response and so do not attain the quality of response of younger patients and do not survive as long. We have investigated whether or not ex vivo cellular sensitivity to cytotoxic drugs could be an underlying biological basis for this age differential in response and survival by comparing ex vivo drug response with age in untreated CLL patients. Cells from 365 untreated CLL patients aged 31.1-87.1 years (average 65.3 years) were tested for drug response by differential staining cytotoxicity (DiSC) assay with a panel of 10 drugs. An average of 280 results (range 196-361) obtained for each drug was compared with patient age. For chlorambucil, cyclophosphamide, prednisolone, vincristine, doxorubicin, epirubicin, fludarabine, cladribine and methylprednisolone, no relationship was found between ex vivo drug response and age (r Ͻ 0.12). For pentostatin, a possible but very weak relationship (r = 0.18; n = 210; P = 0.06) was found. We conclude that cellular sensitivity to cytotoxic drugs does not support the differential treatment of older and younger CLL patients. Leukemia (2000) 14, 712-715.

show abstract

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ex vivo assessment of drug response by differential staining cytotoxicity (DiSC) assay suggests a biological basis for equality of chemotherapy irrespective of age for patients with chronic lymphocytic leukaemia

Bosanquet

2000

Leukemia

View full text Add to dashboard Cite

show abstract

“…Unfortunately, because of this, these patients are at risk for being undertreated [7]. Lung cancer is no exception to this observation; in fact, data show that it can be considered the paradigm of elderly under-representation in clinical research [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Small Cell Lung Cancer in the Elderly

et al. 2005

View full text Add to dashboard Cite

Small cell lung cancer (SCLC) accounts for approximately 20% of lung carcinomas. Chemotherapy is the cornerstone of treatment for SCLC. In limited disease, the median survival time is about 12-16 months, with a 4%-5% long-term survival rate; in extensive disease the median survival time is 7-11 months. More than 50% of lung cancer patients are diagnosed when they are over the age of 65, and about 30% are over 70. Elderly patients tolerate chemotherapy poorly compared with their younger counterparts, because of agerelated progressive reductions in organ function and comorbidities. The standard therapy for limited disease is combined chemoradiotherapy, followed by prophylactic brain irradiation for patients achieving complete responses. In the elderly, the addition of radiotherapy to chemotherapy must be carefully evaluated, considering the slight survival benefit and potential for substantial toxicity incurred with this treatment. The best approach is to design clinical trials that specifically include geriatric assessment to develop active and well-tolerated chemotherapy regimens for elderly SCLC patients. Survival improvement for SCLC patients requires a better understanding of tumor biology and the subsequent development of novel therapeutic strategies. Several targeted agents have been introduced into clinical trials in SCLC, but a minority of these new agents offers a promise of improved outcomes, and negative results are reported more commonly than positive ones. This review focuses on the main issues in the treatment of elderly SCLC patients. The Oncologist 2005;10:399-411The Oncologist 2005;10:399-411 www.TheOncologist.com

show abstract