Oral single-agent chemotherapy in older patients with solid tumours: A position paper from the International Society of Geriatric Oncology (SIOG).
Compared with intravenous (i.v.) chemotherapy, oral administration is convenient, requires fewer healthcare resources, is generally preferred by patients, and may be appropriate in older people with breast, colorectal and lung cancers. The effects of organ dysfunction on drug metabolism and drug interactions in patients with multiple comorbidities must be considered but are not specific to oral chemotherapy. Single-agent oral chemotherapy with capecitabine or vinorelbine is active in older patients with advanced or metastatic breast cancer. Choice of treatment is based mainly on different safety profiles. In the adjuvant treatment of colorectal cancer (CRC), single-agent oral capecitabine is an effective alternative to i.v. fluorouracil (5-FU) regimens. In metastatic CRC, oral, single-agent capecitabine has recently shown encouraging median overall survival in combination with bevacizumab. In non-small cell lung cancer, fit older patients, like their younger counterparts, benefit from platinum-based doublets, with carboplatin preferred to cisplatin. Single agent vinorelbine is an option for those less suited to combination chemotherapy, and oral may be an alternative to i.v. administration. For elderly cancer patients in general, metronomic chemotherapy combines good tolerability with acceptable activity.
Medical Oncology Department, New Prato Hospital, Istituto Toscano Tumori, via Suor Niccolina Infermiera, 20, 59100 Prato, Italy. Electronic address: lbiganzoli@usl4.toscana.it.
L
L
Biganzoli
Memorial Sloan Kettering Cancer Center, New York, USA.
S
S
Lichtman
University of Geneva, Geneva, Switzerland.
J-P
JP
Michel
Department of Medical Oncology, B.O. Cyprus Oncology Centre, Nicosia, Cyprus.
D
D
Papamichael
Department of Pneumology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France.
E
E
Quoix
H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
C
C
Walko
Multidisciplinary Institute of Oncology, Clinique de Genolier, Genolier, Switzerland.
M
M
Aapro
D000284:Administration, Oral; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D057240:Patient Preference / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D016903:Drug Monitoring
D000970:Antineoplastic Agents
Bevacizumab; Breast cancer; Capecitabine; Colorectal cancer; Lung cancer; Metronomic therapy; Older patients; Oral chemotherapy; Vinorelbine