Data relating to cancer treatment in the older patient population are limited because older individuals have been under-represented in clinical trials. The goal of this review was to establish which factors hinder the participation of older individuals to clinical trials and to examine possible solutions.
Methods
The literature relating to cancer treatment in the older patient population was reviewed.
Results
The benefit of systemic cancer treatment may decrease with age, and risks may be increased due to reduced life expectancy and reduced tolerance of stress in the older population. Therefore, a multipronged approach is recommended for clinical studies in these patients, including phase 2 studies limited to persons 70 years of age and older, stratification by life expectancy and predicted treatment tolerance in phase 3 studies, and registration studies to establish predictive variables for treatment-related toxicity in older individuals.
Conclusions
A combination of prospective and registration studies may supply adequate information to study cancer treatments in the older patient population.
References
1.
BalducciL., AaproM.. Complicated and complex: helping the older cancer patients to exit the labyrinth.J Ger Oncol.2014; 5(1): 116–118.
2.
TettamantiM., LuccaU., GandiniF.. Prevalence, incidence, and types of mild anemia in the elderly: the “Health and Anemia” population-based study.Hematologica.2010; 95(11): 1849–1856.
3.
HurriaA., WildesT., BlairS.T.. Senior adult oncology, version 2.2014: clinical practice guidelines in oncology.J Natl Compr Cancer Netw.2014; 12(1): 82–126.
4.
YourmanL.G., LeeS.J., SchonbergM.A.. Prognostic indices for older adults: a systematic review.JAMA.2012; 307(2): 182–192.
5.
LeeS.J., LeipzigR.M., WalterL.C.. Incorporating lag time to benefits into prevention decisions for older adults.JAMA.2013; 310(24): 2609–2610.
6.
ExtermannM., BolerI., ReichR.R.. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score.Cancer.2012; 118(13): 3377–3386.
7.
HurriaA., TogawaK., MohileS.G.. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study.J Clin Oncol.2011; 29(25): 3457–3465.
8.
BalducciL., Goetz-PartenD., SteinmanM.A.. Polypharmacy and the management of the older cancer patient.Ann Oncol.2013; (24 suppl 7): vii36–40.
9.
MohileS.G., FanL., ReeveE.. Association of cancer and geriatric syndromes in older Medicare beneficiaries.J Clin Oncol.2011; 29(11): 1458–1464.
10.
Van CutsemE., ArendsJ.. The causes and consequences of cancer-associated malnutrition.Eur J Oncol Nurs.2005; (9 suppl 2): S51–S63.
11.
MitnitskiA., SongX., RockwoodK.. Assessing biological aging: the origin of deficit accumulation.Biogerontology.2013; 14(6): 709–717.
12.
HuffmanK.M., PieperC.F., KrausV.B.. Relations of a marker of endothelial activation (s-VCAM) to function and mortality in community-dwelling older adults.J Gerontol A Biol Sci Med Sci.2011; 66(12): 1369–1375.
13.
SandersJ.L., NewmanA.B.. Telomere length in epidemiology: a biomarker of aging, age-related disease, both, or neither?Epidemiol Rev.2013; 35(1): 112–131.
14.
FalandryC., GilsonE., RudolphK.L.. Are aging biomarkers clinically relevant in oncogeriatrics?Crit Rev Oncol Hematol.2013; 85(3): 257–265.
15.
JuliussonG., AntunovicP., DerolfA.. Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry.Blood.2009; 113(18): 4179–4187.
16.
TurnerN., ZafaranaE., BecheriD.. Breast cancer in the elderly: which lessons have we learned?Future Oncol.2013; 9(12): 1871–1881.
17.
BalducciL., ErshlerW.B.. Cancer and aging: a nexus at several levels.Nat Rev Cancer.2005; 5(8): 655–662.
18.
EvansJ.L., GoldfineI.D.. Aging and insulin resistance: just say iNOS.Diabetes.2013; 62(2): 346–348.
19.
VelardeM.C., DemariaM., CampisiJ.. Senescent cells and their secretory phenotype as targets for cancer therapy.Interdiscip Top Gerontol.2013; 38: 17–27.
20.
MargelD., UrbachD.R., LipscombeL.I.. Metformin use and all-cause and prostate cancer-specific mortality among men with diabetes.J Clin Oncol.2013; 31(25): 3069–3075.
21.
ChlebowskiR.T., McTiernanA., Wactawski-WendeJ.. Diabetes, metformin, and breast cancer in postmenopausal women.J Clin Oncol.2012; 30(23): 2844–2852.
22.
HoffeS., BalducciL.. Cancer and age: general considerations.Clin Geriatr Med.2012; 28(1): 1–18.
23.
TadmorT., McLaughlinP., PolliackA.. Chemoimmunotherapy with fludarabine, cytoxan and rituximab regimen: to use, not to use, or give it as “FCR-LITE”?Leuk Lymphoma.2014; 55(4): 733–734.
24.
FreedmanV.A.. Research gaps in the demography of aging with disability.Disabil Health J.2014; 7 (1 suppl): S60–S63.
25.
KemenyM.M., PetersonB.L., KomblithA.B.. Barriers to clinical trial participation by older women with breast cancer.J Clin Oncol.2003; 21(12): 2268–2275.
26.
MussH.B., BerryD.A., CirrincioneC.T.. Adjuvant chemotherapy in older women with early-stage breast cancer.N Engl J Med.2009; 360(20): 2055–2065.
27.
MeoniG., CecereF.L., LucheriniE.. Medical treatment of advanced non-small cell lung cancer in elderly patients: a review of the role of chemotherapy and targeted agents.J Geriatr Oncol.2013; 4(3): 282–290.
28.
BastionY., BlayJ.Y., DivineM.. Elderly patients with aggressive non-Hodgkin's lymphoma: disease presentation, response to treatment, and survival–a Groupe d'Etude des Lymphomes de l'Adulte study on 453 patients older than 69 years.J Clin Oncol.1997; 15(8): 2945–2953.
29.
GoedeV., FischerK., BuschR.. Obinutuzumab plus chlorambucil in patients with CLL and coexisting conditions.N Engl J Med.2014; 370(12): 1101–1110.
30.
SanoffH.K., CarpenterW.R., StürmerT.. Effect of adjuvant chemotherapy on survival of patients with stage III colon cancer diagnosed after age 75 years.J Clin Oncol.2012; 30(21): 2624–2634.
31.
LymanG.H., DaleD.C., WolffD.A.. Acute myeloid leukemia or myelodysplastic syndrome in randomized controlled trials of cancer chemotherapy with granulocyte colony-stimulating factor: a systematic review.J Clin Oncol.2010; 28(17): 2914–2924.
