Use of colony-stimulating factors in the elderly cancer patient

Cancer is, in large part, a disease of aging. The progressive decline with age in the functional reserve of specific organs including bone marrow may limit the ability of elderly cancer patients to tolerate treatment. Myelosuppression with neutropenia remains the major dose-limiting toxicity of cancer chemotherapy, especially in the elderly. The hematopoietic growth factors have been shown to reduce the severity and duration of myelosuppression and its complications, including febrile neutropenia and reduced chemotherapy dose intensity. To illustrate the impact of aging, a systematic review was conducted of neutropenic complications and the efficacy of the colony-stimulating factors (CSFs) in elderly patients with non-Hodgkin's lymphoma receiving cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP) or CHOP-like regimens. The risk of febrile neutropenia in this population averages between 25% and 40%, while the use of prophylactic CSF is associated with approximately a 50% reduction in the risk of febrile neutropenia. We also present a systematic review of the use of CSFs in elderly patients with acute myelogenous leukemia. Although there is no consistently observed effect on complete remission rates, there is a significant increase in the proportion of patients alive at 2 years. An economic analysis demonstrates cost savings with the use of CSFs in elderly patients receiving chemotherapy with a dose intensity equivalent to CHOP. Clinical practice guidelines that are consistent with these observations are presented. Further data are needed on the impact of CSFs on quality of life as well as their ability to sustain dose intensity in responsive and potentially curable malignancies in the elderly.

Duke Scholars

Author Gary Herbert Lyman Medicine, Medical Oncology