Welche hämato-onkologischen Medikamente sind im Alter entbehrlich oder ungeeignet?

Abstract

There is a vast amount of drugs and therapeutic regimens available today to treat hemato-oncological diseases. This offers new opportunities to close known gaps of undertreatment in older individuals with cancer, but also increases the risk of overtreatment in this patient group. Currently available criteria (drug listings) for potentially inadequate prescribing in the elderly are not matured enough to serve hemato-oncologists as a guidance when trying to identify unnecessary or inappropriate cancer medication in routine clinical practice. In some clinical situations (e. g., decision-making for adjuvant treatment), online tools that allow for a rough prediction of remaining life expectancy (without or with cancer) as well as chemotherapy toxicity could help to detect risks of overtreatment in individual patients, however. Avoiding chemotherapy in distinct therapeutic situations has become possible for some hematological and solid tumors due to a growing number of novel targeted (i. e. non-cytostatic) drugs. This development appears of particular benefit for elderly patients. The present review discusses tools that generally could support the identification of overtreatment in older patients with such diseases. Drug examples are presented for some common hemato-oncological entities.

Die Zahl der Medikamente bzw. medikamentösen Therapieschemata zur Krebsbehandlung steigt jedes Jahr. Die bloße Verfügbarkeit neuer medikamentöser Therapieoptionen birgt das Risiko einer Überversorgung im Alter. Sind hämato-onkologische Medikamente bzw. Therapieschemata bei alten im Vergleich zu jüngeren Krebspatienten möglicherweise viel weniger wirksam oder deutlich schlechter verträglich? Sind sie dort somit entbehrlich oder sogar ungeeignet?

Schlüsselwörter

Krebs - möglicherweise unangemessene Medikation - Lebenserwartung - Chemotoxizität - zielgerichtete Medikamente - der alte Patient

Key words

cancer - potentially inappropriate medication - life expectancy - chemotherapy toxicity - targeted drugs - elderly

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