Pharmacology of cytotoxic agents: a helpful tool for building dose adjustment guidelines in the elderly

Tranchand, Brigitte; Laporte, Silvy; Gléhen, Olivier

doi:10.1016/j.critrevonc.2003.05.005

Cited by 10 publications

(3 citation statements)

References 147 publications

(162 reference statements)

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“…Fortunately, this is feasible for key pharmacokinetic factors such as hepatic metabolism and urinary clearance because these pathways are often determinants of clinical pharmacokinetic studies. Such indices are used in the titration of drug dosage to help achieve optimal activity and minimal side effects in elderly individuals who use drugs with a narrow therapeutic index (Cutler and Narang 1984; Tranchand et al 2003). …”

Section: Basic Features Of Aging That Can Affect Response To Xenobioticsmentioning

confidence: 99%

Pharmacokinetic and Pharmacodynamic Factors That Can Affect Sensitivity to Neurotoxic Sequelae in Elderly Individuals

Ginsberg

Hattis

Russ

et al. 2005

Environ Health Perspect

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Early-life exposure to agents that modulate neurologic function can have long-lasting effects well into the geriatric period. Many other factors can affect neurologic function and susceptibility to neurotoxicants in elderly individuals. In this review we highlight pharmacokinetic and pharmacodynamic factors that may increase geriatric susceptibility to these agents. There is a decreasing trend in hepatic metabolizing capacity with advancing years that can affect the ability to clear therapeutic drugs and environmental chemicals. This factor combined with decreased renal clearance causes prolonged retention of numerous drugs in elderly individuals. A geriatric pharmacokinetic database was developed to analyze changes in drug clearance with advancing age. This analysis shows that the half-life of drugs processed by hepatic cytochrome P450 enzymes or via renal elimination is typically 50–75% longer in those older than 65 than in young adults. Liver and kidney diseases are more common in elderly individuals and can further decrease the clearance function of these organs. Polypharmacy, the administration of numerous drugs to a single patient, is very common in elderly individuals and increases the risks for drug interaction and side effects. With advancing age the nervous system undergoes a variety of changes, including neuronal loss, altered neurotransmitter and receptor levels, and decreased adaptability to changes induced by xenobiotics. These changes in the central nervous system can make elderly individuals more susceptible to neurologic dysfunction when confronted with single pharmacologic agents, polypharmacy, or environmental toxicants. The many factors that affect elderly responses to neuroactive agents make environmental risk assessment for this age group a special concern and present a unique challenge.

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Section: Basic Features Of Aging That Can Affect Response To Xenobioticsmentioning

confidence: 99%

Pharmacokinetic and Pharmacodynamic Factors That Can Affect Sensitivity to Neurotoxic Sequelae in Elderly Individuals

Ginsberg

Hattis

Russ

et al. 2005

Environ Health Perspect

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Section: Pharmacological Aspectsmentioning

confidence: 99%

“…Renal and hepatic comorbidity are the most relevant MGA parameters that should be verified before chemotherapy administration. Dose reductions according to values of GFR (platinum compounds, bleomycin, cytarabine, methotrexate and, perhaps, cyclophosphamide and capecitabine) or serum bilirubin (doxorubicin, paclitaxel, vinorelbine) or liver transaminases (epirubicin and docetaxel) have been recommended (Tranchand et al 2003;Wildiers et al 2003), but very scanty clinical data are available concerning the real impact of dose reductions in abating adverse events without a detrimental decline in activity. Cardiotoxic drugs such as anthracyclines and hyper-hydration should be administered with extreme caution in patients with a history of cardiological diseases.…”

Section: Phar Macological Aspectsmentioning

confidence: 99%

Multidimensional geriatric evaluation in elderly cancer patients: a practical approach

Basso¹,

Monfardini

2004

Eur J Cancer Care

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Management of cancer in the elderly population is currently perceived as one of the major challenges for clinical research in medical oncology. Multidisciplinary evaluation of the malignant disease and multidimensional assessment of the host represent the key element for correct decision making. Standard methods developed by pioneer geriatric oncologists will be summarized in this review, along with some practical suggestions on when and how they should be employed. Future perspectives concerning some critical issues in multidimensional geriatric assessment will be discussed as well.

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Vulval and Vaginal Cancer

Nadkarni

Ahmed

2012

Management of Gynecological Cancers in Older Women

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Pharmacology of cytotoxic agents: a helpful tool for building dose adjustment guidelines in the elderly

Cited by 10 publications

References 147 publications

Pharmacokinetic and Pharmacodynamic Factors That Can Affect Sensitivity to Neurotoxic Sequelae in Elderly Individuals

Pharmacokinetic and Pharmacodynamic Factors That Can Affect Sensitivity to Neurotoxic Sequelae in Elderly Individuals

Multidimensional geriatric evaluation in elderly cancer patients: a practical approach

Vulval and Vaginal Cancer

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