Department of Medical Oncology, National Cancer Institute of Aviano, Via Franco Gallini 2, 33081 Aviano (PN), Italy.
Anticancer Agents Med Chem. 2013 Nov;13(9):1438-43. doi: 10.2174/18715206113136660352.
The 60% of tumors affected patients >65years of age and the future previsions are considering an amount of 70% after 2030. Elderly Patients presents multiple comorbidity, polipharmacy, and disability. Geriatric assessment helps physicians to take the best therapeutic decisions. Clinical conditions influence efficacy and tolerability of chemotherapy. Prophylactic use of G-CSF after chemotherapy lowers the rate and length of severe neutropenia , and decreases the episodes of febrile neutropenia. Anemia is a hematologic condition associated with ageing , but is frequently associated to concomitant chronic disease. Stem cells display increasing resistance to erythropoietin in the elderly patients and this is connected with the onset of pro-inflammatory cytokines characteristic of this age . Anemia is a common adverse event in cancer patients receiving chemotherapy. Several of the symptoms associated with anemia, such as fatigue, syncope, palpitations and dyspnea, reduce patient activity and have a profound effect on the quality of life [QOL]. Considering the unfit or frail status of elderly patient the at home use of peg-filgrastim and weekly or three weekly erythropoietin administration could be preferred for this setting of patients that lack of specialized nursing care or facilities. Further studies, considering the several differences in health organizations in vary countries, could be held to state the real impact of the biosimilars in comparison to the long acting originators in the reduction of costs in this group of patients.
受影响的肿瘤患者中有 60%年龄>65 岁，预计到 2030 年后将有 70%是老年人。老年患者通常患有多种合并症、多种药物治疗和身体残疾。老年评估有助于医生做出最佳治疗决策。临床状况会影响化疗的疗效和耐受性。化疗后预防性使用 G-CSF 可降低严重中性粒细胞减少症的发生率和持续时间，并减少发热性中性粒细胞减少症的发作。贫血是一种与年龄相关的血液学状况，但常与并存的慢性疾病有关。老年患者的干细胞对促红细胞生成素的抵抗能力增强，这与该年龄组特有的促炎细胞因子的发生有关。贫血是接受化疗的癌症患者常见的不良反应。贫血相关的一些症状，如疲劳、晕厥、心悸和呼吸困难，会降低患者的活动能力，并对生活质量产生深远影响。考虑到老年患者身体虚弱或不适的状况，对于缺乏专业护理或设施的这部分患者，在家中使用培非格司亭和每周或每三周一次的促红细胞生成素治疗可能更为合适。考虑到不同国家的医疗保健组织存在差异，可以进一步开展研究，以确定与长效原研药物相比，生物类似药在降低此类患者的治疗成本方面的实际影响。
