Pharmacokinetic considerations in geriatric cancer patients
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memo https://doi.org/10.1007/s12254-020-00668-z
Pharmacokinetic considerations in geriatric cancer patients Martin Hohenegger
Received: 14 September 2020 / Accepted: 11 November 2020 © The Author(s) 2020
Summary Pharmacological anticancer therapy in elderly people has to account for pharmacokinetic aspects in view of age-related changes in organ function and disease-related alterations. Age-related changes in organ function might still be physiological and have to be discriminated from concomitant diseases and their pharmacotherapy. Although efficacy is retained with pharmacological anticancer therapies in elderly patients, plasma drug concentrations and the incidence of adverse reactions often increase. Thus, altered organ function in elderly will be reviewed with respect to clinically relevant outcomes. Furthermore, possible consequences of therapeutic drug monitoring will be discussed focusing on novel targeted therapies with small molecules. Examples of therapeutic drug monitoring during targeted therapies may represent an easy tool to overcome the individual pharmacokinetic situation of elderly cancer patients and may contribute to enhanced safety, when implemented in clinical routine. Keywords Pharmacokinetics · Gene polymorphisms · Targeted anticancer therapies · Therapeutic drug monitoring · Health services for the aged Abbreviations Minimal plasma concentrations Cmin Ctrough Trough concentration
M. Hohenegger () Centre for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Währingerstraße 13A, 1090 Vienna, Austria [email protected]
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Introduction In Western countries the incidence of cancer increases with age (≥65 years) and consequently is associated with life expectancy [1]. Elderly benefit from chemotherapies similar to other age groups, implying that age per se does not represent a limitation to access an anticancer therapy. Conversely, drug side effects occur more often and are related to age-related changes in organ function, concomitant diseases or drug plasma concentration below or above therapeutic relevant recommendations [2]. The pronounced heterogeneity in health conditions of elderly cancer patients maximizes individualisation of targeted anticancer therapies. The introduction of targeted anticancer therapies has improved the overall outcome in cancer patients including elderly [3, 4]. Beside better prognosis, the incidence and severity of adverse effects have been reduced so that benefit–risk evaluation of novel targeted therapies gradually contribute to favourable overall survival rates including the elderly.
Pharmacokinetic changes in the elderly The performance status of the elderly is dependent on age, comorbidities and their therapies. Aged patients suffer from decreased symptom awareness, which often implicates psychological distress, anxiety or depressive symptoms. Reduced communication may also result from oral and dental problems. Consequently, patients may be categorized simply into fit, vulnerable and fragile or based on a
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