Review Article

Drugs & Aging

, Volume 28, Issue 8, pp 635-649

Systemic Therapies for Metastatic Renal Cell Carcinoma in Older Adults

  • Sumanta K. PalAffiliated withDivision of Genitourinary Malignancies, Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center
  • , Ari VanderwaldeAffiliated withDepartment of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center
  • , Arti HurriaAffiliated withDepartment of Medical Oncology & Experimental Therapeutics, Cancer Control and Population Sciences Program, and Cancer and Aging Research Program, City of Hope Comprehensive Cancer Center
  • , Robert A. FiglinAffiliated withHematology-Oncology, Department of Medicine, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute Email author 

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Abstract

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.