Abstract:
PURPOSE:Older adults receiving cytotoxic agents may be more susceptible to hematologic toxicities because of progressive reduction in organ functions and multiple co-morbidities. Because older adults are under-represented in clinical trials, this retrospective study aims to evaluate hematologic toxicity of gemcitabine-based regimens in older patients compared with their younger counterparts in clinical practice. PATIENTS AND METHODS:A total of 494 patients routinely treated with gemcitabine, either alone or in combination with platinum-based drugs, in the Slotervaart Hospital or The Netherlands Cancer Institute between January 2003 and January 2013 were enrolled. Patient characteristics, underlying malignancy, treatment regimen, administered doses of gemcitabine, and laboratory values were retrospectively collected from electronic patient records. The relative dose intensity achieved in older patients and their younger counterparts was evaluated using the Wilcoxon rank sum test. Incidence of hematologic toxicity in older adults (age ≥70 years) and their younger counterparts (age <70 years) was compared using the Fisher's exact test. Predictors of experiencing Grade 3 or 4 hematologic toxicity were evaluated using logistic regression. RESULTS:Patient characteristics and baseline laboratory values were equally distributed among the two age groups, except for the estimated glomerular filtration rate being significantly lower in the older patients. Reduction of the first administered dose of gemcitabine was significantly more frequently applied in the older patients (p = 0.03). However, no significant difference in the gemcitabine relative dose intensity over the median number of four treatment cycles was observed (65 % in the older patients group vs. 67 % in the younger control group). Incidence of severe hematologic toxicity (Grade ≥3) was not significantly higher in the older patients. A subset analysis of nadir blood counts showed a trend towards an increased incidence of Grade ≥3 hematologic toxicity for the older patients in the gemcitabine-cisplatin treatment group. Moreover, the relative risk for developing Grade 3 or 4 leukocytopenia in the older patients was increased fivefold (p = 0.007) for combination therapy with gemcitabine and cisplatin. Blood transfusions were administered nearly twofold more frequently in the older patients, but this difference did not reach statistical significance. CONCLUSION:Treatment with gemcitabine or a gemcitabine-containing regimen appeared to be feasible and well tolerated in the older patients who were selected to receive chemotherapy. Overall, patients ≥70 years of age did not incur a higher incidence of severe or life-threatening hematologic toxicity nor did they undergo more frequent or larger dose adjustments. These data support additional treatment-specific prospective studies and clinical trials in older cancer patients to optimize treatment benefit and risk in this heterogeneous older patient population.
journal_name
Drugs Agingjournal_title
Drugs & agingauthors
Crombag MR,de Vries Schultink AH,Schellens JH,Beijnen JH,Huitema ADdoi
10.1007/s40266-014-0207-zsubject
Has Abstractpub_date
2014-10-01 00:00:00pages
737-47issue
10eissn
1170-229Xissn
1179-1969journal_volume
31pub_type
杂志文章,多中心研究相关文献
DRUGS & AGING文献大全abstract:BACKGROUND:Older people are exposed to multiple medicines that possess anticholinergic properties. The use of anticholinergic medicines is associated with the risk of morbidity, mortality and cognitive decline, particularly in older people. Anticholinergic exposure can be measured using tools such as the Drug Burden In...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-013-0111-y
更新日期:2013-11-01 00:00:00
abstract::Man and higher primates have adrenals that secrete large amounts of dehydroepiandrosterone (DHEA) [prasterone] and its sulphate (DHEAS) [PB 008]. A remarkable feature of plasma DHEAS levels in humans is their great decrease with aging. Researchers have postulated that this age-related decline of DHEAS levels may expla...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200320130-00001
更新日期:2003-01-01 00:00:00
abstract::Osteoporosis is a common disease that affects 1 in 3 women. Family and twin studies have demonstrated that there is a strong genetic component to this condition. Potential candidate genes examined for their regulatory effect on bone mass include those for collagen type I, estrogen and vitamin D receptors, and various ...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199711050-00001
更新日期:1997-11-01 00:00:00
abstract::Management of hypertension in the elderly should take into account, in particular, the possible negative impact of antihypertensive drugs on the patient's quality of life, the deterioration of which may result in a loss of independence and reduced treatment compliance. Quality of life is recognised as a multifactorial...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200421060-00003
更新日期:2004-01-01 00:00:00
abstract::The main characteristic of acute lymphoblastic leukaemia (ALL) in the elderly is its dismal prognosis. However, other than a lower incidence of T-cell ALL and a greater likelihood of unfavourable chromosomal abnormalities, the clinical and biological characteristics of Philadelphia chromosome-negative (Ph-) ALL in the...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/11592850-000000000-00000
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Treatment of postherpetic neuralgia (PHN) is more complicated in elderly patients, and multiple daily dosing, complex titration, and high incidences of adverse events can be limiting for many pharmacological treatment options. OBJECTIVE:The aim of this study was to determine whether the efficacy and tolerab...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-013-0126-4
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Statins have been associated with later life, long-term care admission in observational studies. However, by preventing vascular events, statins may also prevent or delay admission. We wished to determine statin and long-term care admission associations in a randomised controlled trial context, and describe ...
journal_title:Drugs & aging
pub_type: 杂志文章,随机对照试验
doi:10.1007/s40266-018-0560-4
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Older people are often prescribed multiple drugs with sedative properties. Most research has focused on specific classes of sedative and psychotropic drugs. The cumulative effect of taking multiple drugs with sedative properties has been termed 'sedative load'. Few previous studies have investigated the seda...
journal_title:Drugs & aging
pub_type: 临床试验,杂志文章
doi:10.2165/11317080-000000000-00000
更新日期:2009-01-01 00:00:00
abstract::It is inevitable that publicly funded, technically sophisticated medical treatments will be increasingly rationed. Other things being equal, there is a greater duty to use them to prolong the lives of younger than older people. Age is therefore an ethical rationing criterion. Denial of this may actually harm older peo...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/00002512-199609060-00003
更新日期:1996-12-01 00:00:00
abstract::Influenza causes substantial morbidity across the age spectrum. However, the elderly are especially vulnerable to the serious complications of influenza that might result in hospitalisation or death, and high rates of influenza-associated excess hospitalisation or death that exceed by several-fold the rates seen among...
journal_title:Drugs & aging
pub_type: 杂志文章,meta分析,评审
doi:10.2165/00002512-200522060-00004
更新日期:2005-01-01 00:00:00
abstract::Spasticity following stroke reflects a spectrum of clinical problems including increased muscle tone, abnormal limb posture, excessive contraction of antagonist muscles and hyperactive cutaneous and tendon reflexes. The prevalence of stroke-related disability in stroke survivors is high, and spasticity may be a signif...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199609050-00004
更新日期:1996-11-01 00:00:00
abstract::Despite advances in antimicrobial chemotherapy over recent decades, morbidity and mortality secondary to infection continues to rise. In addition, the incidence of infection caused by resistant organisms has also increased. Concurrently, the elderly are living longer than prior generations, often with disabling chroni...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199813060-00004
更新日期:1998-12-01 00:00:00
abstract::Lisinopril, the lysine analogue of enalaprilat, is a long-acting angiotensin converting enzyme (ACE) inhibitor which is administered once daily by mouth. The efficacy of lisinopril in reducing blood pressure is well established in younger populations, and many trials now show it to be effective in lowering blood press...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199710020-00006
更新日期:1997-02-01 00:00:00
abstract:BACKGROUND:Medication non-adherence can exacerbate disease severity, leading to impairments that interfere with self-care activities in older adults, and, ultimately, death. Elder self-neglect is the most common report to Adult Protective Services (APS) across the USA and is a significant risk factor for early mortalit...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-012-0007-2
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. METHODS:We conducted a cross...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-018-0521-y
更新日期:2018-02-01 00:00:00
abstract::Chronic pain occurs in 45-85% of the geriatric population and the need to treat chronic pain is growing substantially. Unfortunately, treatment for chronic pain is not always correctly targeted, which leads to a reduced quality of life, with decreased socialization, depression, sleep disturbances, cognitive impairment...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/11534670-000000000-00000
更新日期:2009-12-01 00:00:00
abstract:OBJECTIVES:The aims of the study were to evaluate usage rates of warfarin in stroke prophylaxis and the association with assessed stages of stroke and bleeding risk in long-term care (LTC) residents with atrial fibrillation (AFib). METHODS:A cross-sectional analysis of two LTC databases (the National Nursing Home Surv...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-013-0067-y
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:Antidepressant medications have long been implicated as a cause of falls in older people, but there are few data on the risk of falls associated with exposure to serotonin-norepinephrine (noradrenaline) reuptake inhibitors (SNRIs). OBJECTIVE:The aim of this study was to determine the role of SNRIs in older ...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/11592860-000000000-00000
更新日期:2011-11-01 00:00:00
abstract::Chronic obstructive pulmonary disease (COPD) has considerable morbidity and mortality in the older adult population. The role of antibiotics in the management of acute exacerbations of COPD (AECOPD) is currently evolving. Despite only mild benefits, most patients with AECOPD in ambulatory settings receive antibiotics ...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-020-00786-7
更新日期:2020-09-01 00:00:00
abstract::Prostate cancer is a common disease in the elderly, and the number of older prostate cancer patients will probably increase with both the aging of the population and the increased rate of screening. In elderly patients with several co-morbidities, cancer management can be complex, and the risk of administering toxic t...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/11537480-000000000-00000
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND:In the presence of multimorbidity and limited life expectancy (LLE), the need for continued use of preventive medicines becomes uncertain as they may neither improve health nor confer continued health benefits. OBJECTIVE:Our objective was to systematically review the literature to examine the discontinuatio...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-017-0487-1
更新日期:2017-10-01 00:00:00
abstract::Influenza is a major cause of morbidity and mortality in the elderly. Influenza vaccine is recommended for people aged 65 years and older and those in long term care. Currently only 30% of high risk persons are vaccinated. Vaccination generally stimulates an adequate immune response, is well tolerated and is to be enc...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199101060-00003
更新日期:1991-11-01 00:00:00
abstract:OBJECTIVE:To review the influence of age on the response of patients with idiopathic thrombocytopenic purpura (ITP) to corticosteroids, splenectomy and danazol. METHODS:We retrospectively reviewed a cohort of 139 consecutively treated patients with ITP diagnosed between 1985 and 1994. In particular, we analysed the th...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200320110-00005
更新日期:2003-01-01 00:00:00
abstract::Overactive bladder (OAB) is a common constellation of lower urinary tract storage symptoms that causes a significant impact on a person's quality of life. The elderly may be disproportionally impacted by these symptoms due to concomitant poor mobility, comorbid conditions such as diabetes and heart failure, and polyph...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-015-0301-x
更新日期:2015-10-01 00:00:00
abstract::Older adults with chronic kidney disease (CKD) often experience polypharmacy, a recognized predictor of prescribing problems including inappropriately dosed medications, drug-drug and drug-disease interactions, morbidity and mortality. Polypharmacy is also associated with nonadherence, which leads to recurrent hospita...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-018-0593-8
更新日期:2018-11-01 00:00:00
abstract::The alcohol withdrawal syndrome is common in elderly individuals who are alcohol dependent and who decrease or stop their alcohol intake. While there have been few clinical studies to directly support or refute the hypothesis that withdrawal symptom severity, delirium and seizures increase with advancing age, several ...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199914060-00002
更新日期:1999-06-01 00:00:00
abstract::New treatments and treatment protocols for diseases affecting the elderly are evolving as we strive to meet the needs of an aging society. To help you keep up to date with the latest advances worldwide on all aspects of drug therapy and patient management, this section of the journal brings you information selected fr...
journal_title:Drugs & aging
pub_type:
doi:10.2165/00002512-200623080-00005
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Overactive bladder syndrome (OAB) is associated with various co-morbidities; treatment of these frequently results in multiple medication use (MMU) and the potential for drug-drug interactions, which may lead to adverse events and altered efficacy. With the aging population, the prevalence of MMU is likely t...
journal_title:Drugs & aging
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.2165/11586740-000000000-00000
更新日期:2011-02-01 00:00:00
abstract::Healthcare systems worldwide are facing an unprecedented demographic change as globally, the number of older people will triple to 2 billion by the year 2050. The resulting pressures on acute services have been instrumental in the development of intermediate care (IC) as a new healthcare model, which has its origins i...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-013-0133-5
更新日期:2014-01-01 00:00:00
abstract::Restenosis in the months following a successful percutaneous transluminal coronary angioplasty (PTCA) remains the main limitation to this technique for myocardial revascularisation. Despite intensive investigation in this area, no pharmacological therapy has yet been found to be useful in preventing restenosis after c...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199813040-00005
更新日期:1998-10-01 00:00:00