Advanced kidney cancer: treating the elderly

Abstract

Advancing age represents the primary risk factor for renal tumors. Despite findings on the inhibition of angiogenesis that have led to six new drugs to treat metastatic renal cell carcinoma, elderly patients have not been fully represented in clinical trials. In addition, current opinions regarding nephrectomy in elderly patients are conflicting. Available data refer to the efficacy and safety of sorafenib, sunitinib, everolimus, bevacizumab and temsirolimus in patients aged 65 years and older; safety and efficacy data are available only for sunitinib, sorafenib,and everolimus in patients aged 70 years and older and only sorafenib has safety data for patients aged 75 years and older. A different approach based on evaluating comorbidities at baseline, risk of drug interactions and the impact of antitumor treatment in patients with polytherapy regimen is discussed. A decision-making algorithm is proposed to facilitate the selection of the best therapy for kidney tumors for a specific elderly patient profile.

Keywords::

• antiangiogenic
• bevacizumab
• carcinoma
• elderly
• everolimus
• renal
• sorafenib
• sunitinib
• temsirolimus
• therapy

Financial & competing interests disclosure

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Editorial assistance for this manuscript was provided by Dragonfly Editorial funded by Bayer Healthcare.

Key issues

• • Currently available data suggest that elderly patients may tolerate the same treatment of younger patients, even if dose adjustments are required.

• • Not all the therapies could be administered to all elderly patients.

• • The algorithm proposed in (Table 2) takes into account data coming from the literature and an approach focused on patients.

• • Our experience suggests a careful monitoring of elderly patients treated with targeted agents, especially in the early phase of treatment.

Notes

NCCN Guidelines. Senior Adult Oncology v.2.2012.

IFN: Interferon; RCC: Renal cell carcinoma; SIOG: International society of geriatric oncology.

Data taken from [74]