Cancer chemotherapy in the elderly

Gastrointestinal malignancies are very common in the elderly of the U.S. There is controversy about the role of chemotherapy in these elderly patients because of the impression that this population experiences greater toxicity while deriving lesser benefit. Though definitive data is lacking regarding many aspects of chemotherapy in the elderly, some general observations can be made: (a) most chemotherapy agents do not have increased toxicity in the elderly; (b) dosing and regimen should be based more on functional parameters rather than chronologic age; (c) chemotherapy for advanced gastrointestinal malignancies is in general of marginal efficacy and can be potentially toxic, regardless of age; and (d) better prospective studies focusing on the efficacy, toxicity, and quality of life effects of chemotherapy in the elderly should be performed. We review the literature regarding chemotherapy pharmacology, efficacy, and organ-specific toxicity of agents used in gastrointestinal malignancies in the context of these principles.