Adjuvant Chemotherapy in Elderly Patients with Non-Small-Cell Lung Cancer

Cesare Gridelli, MD, Paolo Maione, MD, Daniela Comunale, MD, and Antonio Rossi, MD


Cancer Control. 2007;14(1):57-62. 

In This Article

Age-Related Changes in Organ Function

Elderly patients tolerate chemotherapy poorly because of progressive organ failure related to age and comorbidities. As individuals age, hepatic clearance either decreases or remains unchanged, though generalizations are difficult to make since metabolism is affected by several factors (eg, blood flow, concurrent drug use, disease/physiologic disorders, environmental exposure, gender,genetic differences,liver mass,nutritional intake, physical condition). Some age-related changes in liver function include declines in hepatic blood flow, hepatic organ mass, and the intracellular activity of cytochrome P450 enzymes. These declines can hinder the clearance of drugs from the system, thereby increasing the risk of drug-drug interactions. The risk of hepatic drug-drug interactions can also increase in older individuals because the incidence of polypharmacy increases with age. Declining renal function is an important risk indicator for drug-induced toxicity in elderly patients as most drugs (including metabolites) are excreted via the kidneys. Renal function is therefore an important consideration when administering therapy. Age-related changes in renal function include decreases in renal blood flow, glomerular filtration rate, and creatinine clearance that can alter drug pharmacokinetics and pharmacodynamics.[8]

Decreased hepatic, renal, and bone marrow functions have a negative impact on the degree of drug toxicity, in particular on cisplatin toxicity. A better understanding of the effects of chemotherapeutic agents on older patients and increased knowledge of pharmacokinetic data will help to determine their appropriate use in elderly patients.[9]