Division of Genitourinary Malignancies, Department of Medical Oncology Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
Drugs Aging. 2011 Aug 1;28(8):635-49. doi: 10.2165/11592880-000000000-00000.
The introduction of targeted therapies has radically changed the treatment paradigm for metastatic renal cell carcinoma (mRCC). However, multiple clinical dilemmas have emerged. For instance, limited data are available to juxtapose the safety and efficacy profile of targeted therapies between older and younger adults. Herein, pivotal trials of vascular endothelial growth factor (VEGF)- and mammalian target of rapamycin (mTOR)-directed therapies are assessed in the context of their implications in treating older adults with mRCC. In general, subset analyses from these pivotal studies suggest similar efficacy of targeted therapies amongst older adults. Aging is accompanied by a multitude of physiological changes, as well as an increased prevalence of co-morbidities. The age-related toxicity profiles of targeted agents for mRCC are detailed to provide a framework for the risks and benefits of these therapies in older adults. Ultimately, tools such as the Comprehensive Geriatric Assessment (CGA) that account for physiological (as opposed to chronological) age may prove useful in the evaluation and treatment of older adults with mRCC.
靶向治疗的引入彻底改变了转移性肾细胞癌（mRCC）的治疗模式。然而，出现了多个临床难题。例如，可用的数据有限，无法比较靶向治疗在老年和年轻成年人中的安全性和疗效。在此，评估了血管内皮生长因子（VEGF）和哺乳动物雷帕霉素靶蛋白（mTOR）靶向治疗的关键试验，以了解其对治疗 mRCC 老年患者的意义。一般来说，这些关键研究的亚组分析表明，靶向治疗在老年患者中的疗效相似。衰老伴随着多种生理变化以及合并症的发病率增加。详细介绍了 mRCC 靶向药物的与年龄相关的毒性特征，为这些治疗方法在老年患者中的风险和益处提供了框架。最终，全面老年评估（CGA）等工具（考虑生理年龄而不是实际年龄）可能有助于评估和治疗 mRCC 的老年患者。
