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Particularités de l’usage des agents cytotoxiques chez le sujet âgé

  • Chapter
Les cancers digestifs du sujet âgé

Part of the book series: Oncologie pratique ((ONCOLPRAT))

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Résumé

L’application chez le sujet âgé d’un traitement approprié fondé sur des données scientifi ques est un domaine thérapeutique que l’oncologie médicale commence à aborder de façon optimale. Le retard dans l’application des principes rigoureux de la recherche scientifi que dans le traitement du cancéreux âgé est un fait particulièrement inquiétant (1). En effet, le vieillissement continu des populations des pays d’Europe de l’Ouest où de plus en plus de sujets âgés sont atteints, souffrent et décèdent de cancer, coïncide avec l’augmentation du nombre absolu de patients âgés atteints de cancer dans les pays en voie de développement (2). Il est ainsi paradoxal, bien que compréhensible, que l’oncologie pédiatrique, qui représente numériquement si peu de patients, ait une telle prééminence alors que plus de 50 % des patients adultes atteints de cancer sont habituellement exclus des essais cliniques prospectifs. Le choix du traitement du sujet âgé atteint de cancer est complexe du fait de facteurs supplémentaires potentiels de comorbidité. Ceux-ci incluent parmi d’autres les modifi cations de fonction corporelle dues à l’âge (changements physiologiques), et les modifi cations liées à d’autres maladies concomitantes (comorbidités). Il importe de bien évaluer les effets secondaires attendus par rapport aux bénéfi ces que le patient tirera du traitement en termes de qualité de vie et d’allongement de la survie (3, 4, 5). Ce chapitre a pour but de résumer les adaptations nécessaires du traitement médical aux modifi cations physiologiques observées chez le sujet âgé.

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Références

  1. Fentiman IS (1996) Are the elderly receiving appropriate treatment for cancer. Ann Oncol 7: 657–8

    CAS  PubMed  Google Scholar 

  2. Yancik R (1997) Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 80: 1273–12

    Article  CAS  PubMed  Google Scholar 

  3. Newcomb PA, Carbone PP (1993) Cancer treatment and age: patient perspectives. J Natl Cancer Inst 85: 1580–4

    Article  CAS  PubMed  Google Scholar 

  4. Extermann M, Overcash J, Lyman GH et al. (1998). Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16: 582–7

    Google Scholar 

  5. Coates A (1995) Who shall decide. Eur J Cancer 31: 1917–8

    Article  Google Scholar 

  6. Lindeman RD, Tobin JD, Shock NW (1995) Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 33: 278–85

    Google Scholar 

  7. Wasil T, Lichtman SM (2005) Clinical pharmacology issues relevant to the dosing and toxicity of chemotherapy drugs in the elderly. Oncologist 10: 602–12

    Article  PubMed  Google Scholar 

  8. Cockroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16: 31–41

    Article  Google Scholar 

  9. Marx GM, Blake GM, Galani E et al. (2004). Evaluation of the Cockroft-Gault, Jelliffe and Wright formulae in estimating renal function in elderly cancer patients. Ann Oncol. 15:291–5

    Article  CAS  PubMed  Google Scholar 

  10. Launay-Vacher V, Chatelut E, Lichtman SM, et al. (2007) International Society of Geriatric Oncology. Renal insuffi ciency in elderly cancer patients: International Society of Geriatric Oncology clinical practice recommendations. Ann Oncol. 18:1314–21

    Article  CAS  PubMed  Google Scholar 

  11. Russell RM (1992) Changes in gastrointestinal function attributed to aging. Am J Clin Nutr 55: 1203–7

    Google Scholar 

  12. Durnas C, Loi C, Cusack BJ (1990) Hepatic drug metabolism and aging. Clin Pharmacokinetic 17: 236–63

    Google Scholar 

  13. Tumer N, Scarpace PJ, Lowental DT (1992) Geriatric pharmacology: basic and clinical considerations. Ann Rev Pharmacol Toxicol 32: 271–302

    CAS  Google Scholar 

  14. Johnson SL, Mayerson M, Conrad KA (1985) Gastrointestinal absorption as a function of age: xylose absorption in healthy adults. Clin Pharmacol Ther 38: 331–5

    CAS  PubMed  Google Scholar 

  15. Aapro MS (1996) Oral etoposide and palliative treatment for small-cell lung cancer. Lancet 348: 559–60

    Article  CAS  PubMed  Google Scholar 

  16. Lipschitz DA (1995) Age-related declines in hematopoietic reserve capacity. Semin Oncol 22(suppl. 1): 3–5

    CAS  PubMed  Google Scholar 

  17. Hussain M (1993) Neurotoxicity of antineoplastic agents. Crit Rev Oncol Hematol 14: 6175

    Article  Google Scholar 

  18. Jackson DV, Wells HB, Atkins JN et al. (1998) Amelioration of vincristine related neurotoxicity by glutamic acid. Am J Med 84: 1016–22

    Article  Google Scholar 

  19. Bittigau P, Ikonomidou C (1997) Glutamate in neurologic diseases. J Child Neurol 12: 471–85

    Article  CAS  PubMed  Google Scholar 

  20. Cavaletti G, Zanna C (2002, Sept) Current status and future prospects for the treatment of chemotherapy-induced peripheral neurotoxicity. Eur J Cancer 38: 1832–7

    Article  CAS  PubMed  Google Scholar 

  21. Adkins JC, Peters DH, Markham A (1997) Fludarabine. An update of its pharmacology and use in the treatment of haematological malignancies Drugs 53: 1005–37

    CAS  PubMed  Google Scholar 

  22. Extermann M, Aapro M, Bernabei R et al. (2005) Task Force on CGA of the International Society of Geriatric Oncology. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 55: 241–52

    Article  PubMed  Google Scholar 

  23. Robert J, Hoerni B (1983) Age-dependence of the early phase pharmacokinetics of doxorubicin. Cancer Res 43: 4467–9

    CAS  PubMed  Google Scholar 

  24. Leoni F, Ciolli S, Giuliani C et al. (1995) Attenuated dose idarubicin in acute myelocytic leukemia of the elderly. Pharmacokinetic study and clinical results. Br J Haematol 90: 169–74

    Article  CAS  PubMed  Google Scholar 

  25. .Lichtman SM, Wildiers H, Launay-Vacher V et al (2007) International Society of Geriatric Oncology (SIOG) recommendations for theadjustment of dosing in elderly cancer patients with renal insuffi ciency. Eur J Cancer 43:14–34

    Article  PubMed  Google Scholar 

  26. Calvert DH, Newell DR, Gumbrell LA et al. (1989) Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 7: 1748–56

    CAS  PubMed  Google Scholar 

  27. Gelman RS, Taylor SG (1984) Cyclophosphamide, methotrexate and 5-fl uorouracil chemotherapy in women greater than 65 years old with advanced breast cancer. The elimi-nation of age trends in toxicity by using doses based on creatinine clearance. J Clin Oncol 2: 1406–14

    Google Scholar 

  28. Kintzler PE, Dorr RT (1995) Anticancer drug renal toxicity and elimination: dosing guide-lines for altered renal function. Cancer Treat Rev 21: 33–64

    Article  Google Scholar 

  29. Burkowski JM, Dürr M, Donehower RC et al. (1994) Relation between age and clearance rate of nine investigational anticancer drugs from phase I pharmacokinetic data. Cancer Chemother Pharmacol 33: 493–6

    Article  Google Scholar 

  30. Hrusheshky JM, Shimp W, Kennedy BJ (1984) Lack of age-dependent cisplatin nephrotoxicity. Am J Med 76: 579–80

    Article  Google Scholar 

  31. Thyss A, Saudes L, Otto J et al. (1994) Renal tolerance of cisplatin in patients more than 80 years old. J Clin Oncol 12: 2121–5

    CAS  PubMed  Google Scholar 

  32. Blower P, de Wit R, Goodin S, Aapro M (2005) Drug-drug interactions in oncology: why are they important and can they be minimized? Crit Rev Oncol Hematol 55:117–42

    Article  PubMed  Google Scholar 

  33. Spencer CM, Goa KL (1995) Amifostine: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential as a radioprotector and cytotoxic chemo-protector. Drugs 50: 1001–31

    Article  CAS  PubMed  Google Scholar 

  34. Cascinu S, Cordella L, Del Ferro E et al. (1995) Neuroprotective effect of reduced gluta-thion on cisplatin based chemotherapy in advanced gastric cancer: a randomized double-blind placebo-controlled trial. J Clin Oncol 13: 26–32

    CAS  PubMed  Google Scholar 

  35. Smyth JF, Bowman A, Perren T et al. (1997) Glutathion reduces the toxicity and improves quality of life of women diagnosed with ovarian cancer treated with cisplatin: results of a double-blind, randomised trial. Ann Oncol 8: 569–73

    Article  CAS  PubMed  Google Scholar 

  36. Speyer JL, Green MD, Zeleniuch-Jacquotte A et al. (1992). ICRF-187 permits longer treat-ment with doxorubicin in women with breast cancer. J Clin Oncol 10: 117–27

    CAS  PubMed  Google Scholar 

  37. Lopez M, Vici P, Di Lauro L et al. (1998). Randomized prospective clinical trial of highdose epirubicin and dexrazoxane in patients with advanced breast cancer and soft tissue sarcomas. J Clin Oncol 16: 86–92

    CAS  PubMed  Google Scholar 

  38. O’Brien ME, Wigler N, Inbar M et al. CAELYX Breast Cancer Study Group (2004). Reduced cardiotoxicity and comparable effi cacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYX/Doxil) versus conventional doxorubicin for fi rst-line treatment of metastatic breast cancer. Ann Oncol 15: 440–9

    Article  PubMed  Google Scholar 

  39. Witherby SM, Muss HB (2005) Special issues related to breast cancer adjuvant therapy in older women.Breast 14:600–11

    Article  CAS  PubMed  Google Scholar 

  40. Gridelli C, Aapro M, Ardizzoni A et al. (2005) Treatment of advanced non-small-cell lung cancer in the elderly: results of an international expert panel. J Clin Oncol 23: 3125–37

    Article  CAS  PubMed  Google Scholar 

  41. Rudd GN, Hartley JA, Souhami RL (1995) Persistence of cisplatin induced DNA interstrand crosslinking in peripheral blood mononuclear cells from elderly and younger individuals. Cancer Chemother and Pharmacol 35: 323–6

    Article  CAS  Google Scholar 

  42. Stein BN, Petrelli N, Douglass HO et al. (1995) Age and sex are independent predictors of 5-fl uorouracil toxicity. Cancer 75: 11–7

    Article  CAS  PubMed  Google Scholar 

  43. Milano G, Etienne MC, Cassuto-Viguier E et al. (1992) Influence of age and sex on fluorouracil clearance. J Clin Oncol 10: 1171–5

    CAS  PubMed  Google Scholar 

  44. Monfardini S, Sorio R, Kaye S (1994) Should elderly cancer patients be entered into dose-escalation studies? Ann Oncol 5: 964–5

    CAS  PubMed  Google Scholar 

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  1. Multidisciplinary Oncology Institute, Clinique de Genolier, 1, route du Muids, CH-1272, Genolier, Suisse

    Matti S. Aapro

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  1. Matti S. Aapro
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Aapro, M.S. (2010). Particularités de l’usage des agents cytotoxiques chez le sujet âgé. In: Les cancers digestifs du sujet âgé. Oncologie pratique. Springer, Paris. https://doi.org/10.1007/978-2-8178-0000-4_6

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  • DOI: https://doi.org/10.1007/978-2-8178-0000-4_6

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-287-79513-8

  • Online ISBN: 978-2-8178-0000-4

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