Abstract
Background: Elderly patients receiving anticancer drugs may have an increased risk to develop treatment-related toxicities compared to their younger peers. However, a potential pharmacokinetic (PK) basis for this increased risk has not consistently been established yet. Therefore, the objective of this study was to systematically review the influence of age on the PK of anticancer agents frequently administered to elderly breast cancer patients. Methods: A literature search was performed using the PubMed electronic database, Summary of Product Characteristics (SmPC) and available drug approval reviews, as published by EMA and FDA. Publications that describe age-related PK profiles of selected anticancer drugs against breast cancer, excluding endocrine compounds, were selected and included. Results: This review presents an overview of the available data that describe the influence of increasing age on the PK of selected anticancer drugs used for the treatment of breast cancer. Conclusions: Selected published data revealed differences in the effect and magnitude of increasing age on the PK of several anticancer drugs. There may be clinically-relevant, age-related PK differences for anthracyclines and platina agents. In the majority of cases, age is not a good surrogate marker for anticancer drug PK, and the physiological state of the individual patient may better be approached by looking at organ function, Charlson Comorbidity Score or geriatric functional assessment.
Highlights
The majority of patients diagnosed with cancer are aged 65 years and older, and it is predicted that in the period from 2010–2030, the cancer incidence in the elderly will increase by 67% [1]
Patients receiving anticancer drugs may have an increased risk to develop treatment-related toxicities compared to their younger peers
Altered distribution of docetaxel can be expected in the elderly patient who has an altered body composition and increased serum α1-acid glycoprotein [11,12]
Summary
The majority of patients diagnosed with cancer are aged 65 years and older, and it is predicted that in the period from 2010–2030, the cancer incidence in the elderly will increase by 67% [1]. Patients (often defined as ě65 years of age) are routinely treated with anticancer drugs; the pharmacokinetics and pharmacodynamics (PK and PD) of these agents have not been thoroughly investigated in this population far. Despite the increasing size of the geriatric population and specific guidance on studies in geriatrics [2], the elderly patient is mostly excluded from clinical trials due to short life expectancy, performance status, comorbidities and/or comedication [3,4]. Identification of the appropriate dosage regimen of an anticancer drug for the respective target population, including elderly patients, is crucial to ensure its safety and effectiveness in clinical practice. The objective of this study was to systematically review the influence of age on the PK of anticancer agents frequently administered to elderly breast cancer patients. Publications that describe age-related PK profiles of selected anticancer drugs against breast cancer, excluding endocrine compounds, were selected and included
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