Lichtman Stuart M
Memorial Sloan-Kettering Cancer Center, Commack, NY 11725, USA.
Interdiscip Top Gerontol. 2013;38:104-23. doi: 10.1159/000343618. Epub 2013 Jan 17.
The elderly comprise the majority of patients with cancer and are the recipients of the greatest amount of chemotherapy. Unfortunately, there is a lack of data to make evidence-based decisions with regard to chemotherapy. This is due to the minimal participation of older patients in clinical trials and that trials have not systematically evaluated chemotherapy. This chapter reviews the available information with regard to chemotherapy and aging. Due to the lack of prospective data, the conclusions and recommendations made are a consensus of the available information. Extrapolation of data from younger to older patients is necessary, particularly to those patients older than 80 years, for which data is almost entirely lacking. The classes of drugs reviewed include alkylators, antimetabolites, platinum compounds, anthracyclines, taxanes, purine analogues, antimicrotubule agents, camptothecins, and epipodophyllotoxins. Clinical trials need to incorporate an analysis of chemotherapy in terms of the pharmacokinetic and pharmacodynamic effects of aging. In addition, data already accumulated need to be re-analyzed by age to aid in the management of the older cancer patient.
老年患者占癌症患者的大多数，也是接受化疗最多的人群。不幸的是，缺乏数据来做出关于化疗的循证决策。这是由于老年患者参与临床试验的比例极低，且试验未对化疗进行系统评估。本章回顾了关于化疗与衰老的现有信息。由于缺乏前瞻性数据，所得出的结论和建议是基于现有信息的共识。有必要将年轻患者的数据外推至老年患者，尤其是80岁以上的数据几乎完全缺失的患者。所回顾的药物类别包括烷化剂、抗代谢物、铂类化合物、蒽环类、紫杉烷类、嘌呤类似物、抗微管药物、喜树碱类和鬼臼毒素类。临床试验需要纳入对化疗在衰老的药代动力学和药效学方面的分析。此外，已积累的数据需要按年龄重新分析，以辅助老年癌症患者的管理。
