Hemopoietic Reserve in the Older Cancer Patient: Clinical and Economic Considerations

Balducci, Lodovico; Hardy, Cheryl L.; Lyman, Gary H.

doi:10.1177/107327480000700605

Cited by 74 publications

(42 citation statements)

References 44 publications

(55 reference statements)

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“…Hematopoietic reserve, a primary determinant of myelosuppression with cytotoxic therapy, is thought to decrease with age. 28 Febrile neutropenia occurred in 44% of patients aged 50 years who received first-line platinum-based chemotherapy, including 6 who received prophylactic granulocyte colony-stimulating factor. This rate is significantly higher than that reported with BEP and EP in randomized trials (5%-23%).…”

Section: Discussionmentioning

confidence: 99%

Clinical features, presentation, and tolerance of platinum‐based chemotherapy in germ cell tumor patients 50 years of age and older

Feldman

Voss

Jacobsen

et al. 2013

Cancer

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BACKGROUND: Germ cell tumors (GCTs) primarily affect adolescent and young adult men. Detailed clinical and treatment characteristics in older men are lacking. METHODS: Patients with GCT seen over a 20-year period at Memorial Sloan-Kettering Cancer Center were identified. Primary tumor site and histology were compared for patients aged 50 years at diagnosis versus younger men. For patients aged 50, individual chart review was performed and treatment delays, changes, and toxicities were recorded for those treated with first-line chemotherapy. RESULTS: Of 4235 diagnoses of GCT, 3999 (94.4%) were made at age < 50 versus 236 (5.6%) at age 50. Compared with patients diagnosed before age 50, older men more frequently had seminoma (62.7% versus 36.7%) and less frequently, nonseminoma (34.7% versus 63.2%) (P <.0001). Predominant histology switched from nonseminoma to seminoma around age 35. Distribution of primary sites also differed for older versus younger men (testis: 89.4% versus 92.9%; retroperitoneal: 3.8% versus 0.7%; CNS 0% versus 1.7%) except for mediastinal primary tumors, which remained constant across age groups. Fifty patients age 50 received first-line platinum-based chemotherapy; 30 experienced complications leading to treatment discontinuation, delay 7 days, or regimen change. Twenty-two (44%) patients experienced neutropenic fever, 6 despite prophylactic growth factor support. Estimated 5-year survival for chemotherapy-treated patients was 84.9%. CONCLUSIONS: Men aged 50 years comprise less than 10% of GCT diagnoses and have distinct clinical and histological characteristics as compared with younger patients. Although complications from chemotherapy occur frequently in older men, prognosis remains excellent when risk-directed treatment is administered with curative intent. Cancer 2013;119:2574-81. V C 2013 American Cancer Society.KEYWORDS: germ cell tumors; testicular cancer; age over 50; epidemiology; histology; primary site; cisplatin. INTRODUCTIONGerm cell tumors (GCTs) primarily affect adolescent and young adult men, with diagnoses in older patients, children, and women occurring much less commonly. In men, most GCTs arise in the testis but extragonadal primary tumor sites comprise up to 10% of cases, typically in midline locations such as the mediastinum, retroperitoneum, or pineal gland. The World Health Organization classification of tumors 1 categorizes GCTs in adolescents and adults into 3 histologic groups: classic seminoma with pure histology; nonseminomatous GCT (NSGCT), comprising embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, and mixed histologies (which can include seminoma); and spermatocytic seminoma.2 In most epidemiological studies, rates of seminoma slightly exceed those of NSGCT, 3,4 with spermatocytic seminoma comprising < 1% of cases. The incidence of seminoma and NSGCT differs across age groups, peaking between ages 35 and 39 years for seminoma compared with 25 to 29 years for NSGCT. 4 Nevertheless, both histologic types are rare in older men with fewer than 10% a...

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Section: Discussionmentioning

confidence: 99%

Clinical features, presentation, and tolerance of platinum‐based chemotherapy in germ cell tumor patients 50 years of age and older

Feldman

Voss

Jacobsen

et al. 2013

Cancer

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“…Approximately 30% of those diagnosed are patients aged 70 years or older (Hutchins et al, 1999;Greenlee et al, 2001). Treatment of elderly NSCLC patients represents a challenge in clinical practice, because these patients are not eligible for aggressive therapies due to the age-related reduction of the functional reserve of many organs and comorbidities (Balducci et al, 2000). Recent data suggest that platinum-based chemotherapy can be safely proposed to the elderly (Langer et al, 2002), but so far mainly single-agent chemotherapy with vinorelbine or gemcitabine has been considered as the standard treatment for advanced disease (Gridelli et al, 2003).…”

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confidence: 99%

Efficacy and tolerability of gefitinib in pretreated elderly patients with advanced non-small-cell lung cancer (NSCLC)

et al. 2004

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“…Besides comorbid conditions, age by itself impairs the patients’ capacities, with notable consequences on physiological functions of bone marrow, liver, kidney and others. It is well known that bone marrow function is depleted in old age, therefore emphasizing the myelotoxicity of various chemotherapy regimens [28]. Delayed toxicity, including febrile neutropenia, and thrombopenia-related bleeding must be considered because due to social and psychological circumstances as well as a lessened symptom awareness, older people are likely to seek medical care with delay in case of treatment complications [28].…”

Section: Pitfalls Of Cancer Care In the Elderlymentioning

confidence: 99%

Geriatric Oncology: How Far Have We Gone and What Are the Next Steps?

Kurtz

Heitz

Kurtz-Illig³

et al. 2009

Oncology

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Geriatric oncology is increasingly developing in Western countries as it is established that cancer peaks after 60 years of age, and the populations are inexorably aging. Aging is associated with a decrease in the use of chemotherapy, and some patients are therefore exposed to undertreatment. Comprehensive geriatric assessment is a composite of several scores that target the multidimensional aspects of the old person. With the use of comprehensive geriatric assessment, geriatricians and oncologists can tailor treatment to their patients. In this review, we briefly describe the characteristics of elderly cancer patients, and identify the pitfalls of anticancer treatment in elderly patients. In light of our expertise, we describe the benefits that can be awaited from joint efforts from geriatricians and oncologists and suggest future directions to answer unmet needs.

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Hemopoietic Reserve in the Older Cancer Patient: Clinical and Economic Considerations

Cited by 74 publications

References 44 publications

Clinical features, presentation, and tolerance of platinum‐based chemotherapy in germ cell tumor patients 50 years of age and older

Clinical features, presentation, and tolerance of platinum‐based chemotherapy in germ cell tumor patients 50 years of age and older

Efficacy and tolerability of gefitinib in pretreated elderly patients with advanced non-small-cell lung cancer (NSCLC)

Geriatric Oncology: How Far Have We Gone and What Are the Next Steps?

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