Gastrointestinal Oncology, Department of Medicine, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
Gastrointestinal Oncology, Department of Medicine, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
Cancer Treat Rev. 2020 Apr;85:101980. doi: 10.1016/j.ctrv.2020.101980. Epub 2020 Feb 10.
Gastric cancer is considered an age-related disease, with the majority of new cases in the UK diagnosed in individuals over the age of 75. At present most guidance related to the management of gastric cancer is based on trials undertaken in the fit, younger patient. Historically the elderly have been underrepresented in clinical trials, which frequently have a restricted inclusion to an upper age limit of 75. The European Society for Medical Oncology (ESMO) recommends use of a geriatric assessment to determine functional age when initiating treatment in elderly patients with gastric cancer, which has been shown to be a better predictor of treatment response than chronological age. The physiological changes that occur with age, including reduced organ function and pharmacokinetic and pharmacodynamic variability, together with impaired functional status, necessitate a more individualised approach to treatment decisions in the older patient to provide them with the same advantages from radical treatment and palliative chemotherapy as younger patients. This review summarises the current evidence extrapolated from trial data on how best to optimise treatment for elderly patients with gastric cancer.
胃癌被认为是一种与年龄相关的疾病，在英国，大多数新病例发生在 75 岁以上的人群中。目前，大多数与胃癌管理相关的指南都是基于对健康、年轻患者进行的试验制定的。从历史上看，老年人在临床试验中的代表性不足，这些临床试验通常将纳入年龄限制在 75 岁以上。欧洲肿瘤内科学会（ESMO）建议在开始治疗 75 岁以上的老年胃癌患者时使用老年评估来确定功能年龄，这一评估已被证明比实际年龄更能预测治疗反应。随着年龄的增长而发生的生理变化，包括器官功能下降、药代动力学和药效动力学的可变性以及功能状态受损，需要对老年患者的治疗决策采取更个体化的方法，为他们提供与年轻患者一样的根治性治疗和姑息性化疗的优势。这篇综述总结了从临床试验数据中推断出的关于如何为老年胃癌患者优化治疗的现有证据。
