Effect of age on drug metabolism in women with breast cancer.
BACKGROUND
The aging of the population will increase the number of breast cancer patients requiring treatment in both the adjuvant and metastatic setting. Hormones, chemotherapy and targeted drugs all have a role in treatment. Older patients have been underrepresented in clinical trials making evidence-based decisions difficult. The increase in comorbidity and aging, polypharmacy and changes in function make pharmacotherapy decisions more complicated. Knowledge of the issues is critical in the prescribing of effective and safe therapy. There are factors associated with advancing age that can result in pharmacokinetic and pharmacodynamic variations in processing of hormonal agents, chemotherapy and targeted drugs.


METHODS
A review of the literature pertaining to pharmacokinetic changes in aging in breast cancer was untaken. Studies are reviewed involving single agents and some combinations.


CONCLUSIONS
Older patients should be considered for standard therapies. Their specific problems need to be evaluated by geriatric-specific assessment including functional status, end organ dysfunction and polypharmacy. There are few instances for age-related changes in pharmacokinetics and when present are usually not clinically significant. When changes are present, they are often the result of comorbidity, drug interactions and drug scheduling issues. The older patients may be more sensitive to certain toxicities such as cardiac toxicity, neuropathy and myelosuppression.
Memorial Sloan Kettering Cancer Center , 650 Commack Road, Commack, NY 11725 , USA +1 631 623 4100 ; +1 631 864 3827 ; singhj@mskcc.org.
Jasmeet C
JC
Singh
Stuart M
SM
Lichtman
D000367:Age Factors; D000375:Aging; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D004347:Drug Interactions; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D058990:Molecular Targeted Therapy; D009362:Neoplasm Metastasis; D019338:Polypharmacy
D000970:Antineoplastic Agents
CYP450; elderly; geriatrics; pharmacodynamics; pharmacokinetics; polypharmacy; renal insufficiency