Department of Oncology, Montefiore Medical Center-North Division/New York Medical College, 600 East 233rd Street, Bronx, NY 10466, USA.
Med Oncol. 2010 Dec;27(4):1359-70. doi: 10.1007/s12032-009-9388-4. Epub 2009 Dec 31.
Renal cell carcinoma primarily affects older individuals. Approximately half of all new renal cell carcinoma diagnoses are made in persons 65 years of age or older. Devising a treatment plan for the elderly patient population requires special consideration. Age-related physiological, cognitive, and social characteristics of elderly patients may influence each stage of patient care. Until recently, treatment options were limited for elderly patients with renal cell carcinoma. Sorafenib is the first multikinase inhibitor approved for use in renal cell carcinoma in the United States and Europe. In the phase III Treatment Approaches in Renal Cell Cancer Global Evaluation Trial, sorafenib significantly extended progression-free survival in patients with advanced renal cell carcinoma, regardless of age. Incidence rates of adverse events were not significantly higher in elderly patients receiving sorafenib than in younger patients. Thus, sorafenib represents an important treatment option for elderly patients with renal cell carcinoma. This report describes particular considerations for physicians to be aware of when choosing a treatment regimen for their elderly patients with renal cell carcinoma and offers recommendations on how to integrate specific management strategies into clinical practice that will optimize the use of sorafenib in the elderly. The strategies focus on patient selection, assessment of quality of life, management of adverse events, and appropriate dose modifications. The goal of these recommendations is to maximize the clinical benefit of sorafenib in the elderly patient population through appropriate use.
肾细胞癌主要影响老年人。大约一半的新诊断肾细胞癌发生在 65 岁或以上的人群中。为老年患者群体制定治疗计划需要特别考虑。老年患者的与年龄相关的生理、认知和社会特征可能会影响患者护理的各个阶段。直到最近，老年肾细胞癌患者的治疗选择有限。索拉非尼是美国和欧洲批准用于肾细胞癌的第一种多激酶抑制剂。在肾细胞癌全球评估试验的治疗方法的 III 期临床试验中，无论年龄如何，索拉非尼都显著延长了晚期肾细胞癌患者的无进展生存期。接受索拉非尼治疗的老年患者不良事件发生率与年轻患者相比没有显著增加。因此，索拉非尼是老年肾细胞癌患者的重要治疗选择。本报告描述了医生在为老年肾细胞癌患者选择治疗方案时需要注意的特定问题，并就如何将特定的管理策略纳入临床实践以优化索拉非尼在老年患者中的应用提出了建议。这些策略侧重于患者选择、生活质量评估、不良事件管理和适当的剂量调整。这些建议的目的是通过合理使用，最大限度地提高老年患者群体中索拉非尼的临床获益。
