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Objectives: There are many chemotherapy protocols, e.g. FoLFOx, to guide dosing. However, dose reductions due to severe side effects (ADR) are common and information on the doses really administered is scarce. Our hypothesis was that especially elderly patients receive lower doses than younger ones. The aim of our study was therefore to test this hypothesis and to investigate safety and quality of life (QoL) in elderly patients treated with an oxaliplatin-based chemotherapy (CTx).
Methods: Observational field study with colorectal cancer patients receiving oxaliplatin in the outpatient oncology ward of a German secondary care clinic. Specified labs and ADR as well as self-reported QoL were obtained by a clinical pharmacist until therapy was ended.
Results: Our study included 214 CTx courses for 18 patients, four of which were <65 years (median 58.7, ‘younger') and the remaining ones 65 years and above (median 73.4, ‘elderly'). Younger patients received 100% of the target oxaliplatin dose until course 7 and linear dose reductions in the following courses, reaching a mean of 25% of the target dose at course 12. In contrast, elderly patients received slightly reduced doses right from the beginning, but in spite of further subsequent dose reductions the level stayed above 50% of the target dose. The reason for 82% of dose reductions in younger patients was neurotoxicity, whereas in elderly patients, neurotoxicity caused 27%, thrombopenia 23% and ‘old age' per se 21% of reductions. Predominant ADR in younger patients were neurotoxicity, nausea and vomiting, while elderly patients showed higher degrees of thrombopenia and alopecia. Self-reported global QoL was lower in younger than in elderly patients.
Conclusions: Oxaliplatin therapy is feasible, with manageable toxicity and acceptable QoL, in elderly patients. It remains to be investigated whether the different dosage time-courses in younger and elderly patients yield outcome differences.