Artikel
Is gemcitabine based chemotherapy feasible in elderly patients with advanced bladder cancer without any problems? - Investigations about the influence of age and comorbidity on therapy caused morbidity and mortality in elderly patients with gemcitabine based chemotherapy
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Veröffentlicht: | 20. März 2006 |
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Gliederung
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Introduction: Today, 60% of all patients (pts.) with cancer are older than 65 years. Elderly patients represent a troublesome entity for the feasibility of chemotherapies because age associated changes in organ function and multiple comorbidities might have a negative impact on toxicity. We investigated the influence of age and comorbidities on the frequency of treatment associated side effects in pts. with advanced bladder cancer undergoing adjuvant and inductive gemcitabine based chemotherapies.
Methods: 78 pts. with advanced bladder cancer were treated with 247 cycles (mean 3.2 cycles) of gemcitabine based chemotherapy (53 pts. gemcitabine / cisplatin, 17 pts. gemcitabine / taxol, 8 pts. gemcitabine, only). Mean age of the pts. was 65.2 (40-85) years. The side effects of chemotherapy were documented by the WHO index. Comorbidities were examined by the Charlson index (CI), which is further established and focuses on the influence of comorbidities on diseases and therapy process. Here each distant metastatic tumor obtains a maximum value of 6 points.
Results: 44/78 pts. (56.4%) demonstrated WHO 0-2 toxicities and 34/78 (43.6%) showed WHO 3-4 toxicities. In this latter group side effects concerned: Hematopoiesis 14 pts., gastrointestinal had 4 pts., renal function had 3 pts., pulmonal function had 2 pts., fever had 3 pts., skin problem had 1 pt. and reduced general condition had 4 pts. 31/78 pts. (39.7%) encountered significant toxicities. We recorded 2 therapy caused deaths (2.6%), the dose had to be reduced by 50% in 5 pts. (7.7%) and in 24 pts. (33.3%) chemotherapy had to be discontinued due to intolerable side effects. While there were no problems in 7/8 pts. with a CI of 0, 16.7% of the pts. with a CI of 1, 30% of the pts. with a CI of 2 and 52.1% of the pts. with a CI of 6 developed significant toxicities. 53.9% of the pts. less than 60 years, 17.4% of the pts. between 60 and 65 years and 38.5% of the pts. between 66 and 70 years displayed serious side effects. 55% of the pts. between 71 and 75 years had serious complications due to chemotherapy, though 85% of these pts. had a CI of 6. Only 3/8 pts. older than 75 years showed serious problems; also their CI was 6. Among all pts. with serious problems due to chemotherapy 87.5% had a CI of 6 versus 50% in the group of pts. with no problems.
Conclusions: In contrast to a high comorbidity index, age did not have a negative influence on the morbidity and the occurrence of serious side effects in gemcitabine based chemotherapies. We conclude that gemcitabine based chemotherapy of bladder cancer in elderly patients is feasible without problems. Independent of age, chemotherapy is problematic in patients with a CI of 6, because the rate of associated significant side effects in this group is 50% and include therapy caused deaths.