Cancer, clinical pharmacology, and aging

The changes in the pharmacology of cancer chemotherapeutic agents related to age remain largely unexplored. Certain physiologic changes are well documented and dictate changes in therapy such as the decrease in CCNU and methotrexate dosage. Other toxicities are also shown to correlate with age, such as bleomycin toxicity. However, in several retrospective studies of combination therapy, arbitrary dose reductions have probably impacted negatively on survival. Further prospective investigation will be required in order to develop more rational approaches to cancer chemotherapy in the elderly. There is an urgent need to systematically examine the impact of age on the pharmacology of antineoplastic agents. Trials and clinical treatments uniquely designed for older cancer patients are essential in order to develop rational approaches to management.