Drug utilization, adherence, and unique side effects of targeted therapy in older adults
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© Cambridge University Press 2010.Introduction Cancer is a disease of older adults. Approximately 60 percent of cancer diagnoses and 70 percent of cancer mortality occur in individuals aged 65 years and older. As the general population ages and life expectancy increases, the number of older adults with cancer is growing. Several unique challenges arise in caring for older adults with cancer. In particular, the physiologic changes associated with aging can have an impact on the pharmacokinetics and pharmacodynamics of cancer therapies. The effects of these age-related changes on drug dosing and tolerance have been understudied as clinical trials that set the standards for oncology care and drug approval have typically focused on a younger patient population. In this chapter, we will review the physiologic changes associated with aging and how they may impact the safety, tolerability, and efficacy of and adherence to cancer treatment. We will also review the limited data of novel targeted oncology drugs in the elderly. Physiologic changes with aging Aging is a heterogenous process; however, some characteristic changes in physiology and organ function can have an impact on the pharmacology and toxicity of anticancer therapy. For example, age-related changes in the gastrointestinal tract may affect drug absorption. These changes include a decrease in splanchnic blood flow, gastrointestinal motility, secretion of digestive enzymes, and mucosal atrophy. With increasing age, hepatic mass decreases, and there is a decrease in the cytochrome P450 content in liver biopsies, although the impact of these declines on hepatic function remains controversial.
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