Optimal management of renal cell carcinoma in the elderly: a review
Amandine Quivy,1,2 Amaury Daste,1 Asma Harbaoui,1 Sophie Duc,2,4 Jean-Christophe Bernhard,2,3 Marine Gross-Goupil,1 Alain Ravaud1,2 1Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France; 2University of Bordeaux 2 (Victor S&eacut...
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doaj-168e8bb7ac2944858bb611e80520faad2020-11-25T02:48:04ZengDove Medical PressClinical Interventions in Aging1178-19982013-04-01Volume 843344212823Optimal management of renal cell carcinoma in the elderly: a reviewQuivy ADaste AHarbaoui ADuc SBernhard JCGross-Goupil MRavaud AAmandine Quivy,1,2 Amaury Daste,1 Asma Harbaoui,1 Sophie Duc,2,4 Jean-Christophe Bernhard,2,3 Marine Gross-Goupil,1 Alain Ravaud1,2 1Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France; 2University of Bordeaux 2 (Victor Ségalen), Bordeaux, France; 3Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France; 4Department of Geriatrics, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France Abstract: Both the aging population and the incidence of renal cell carcinoma (RCC) are growing, making the question of tumor management in the elderly a real challenge. Doctors should be aware of the importance of assessing this specific subpopulation. An aggressive therapeutic approach may be balanced by the benefit of the treatment – care or cure – and the life expectancy and willingness of the patient. The treatment for local disease can be surgery (radical or partial nephrectomy) or ablative therapies (radiofrequency, cryotherapy). Even if in most cases surgery is safe, complications such as alteration of renal function may occur, especially in the elderly, with physiological renal impairment at baseline. More recently, another option has been developed as an alternative: active surveillance. In the past decade, new drugs have been approved in the metastatic setting. All the phase 3 trials have included patients without a limit on age. Nevertheless, data concerning the elderly are still poor and concern only a very selective subpopulation. The toxicity profile of targeted agents may interfere with pre-existent comorbidities. Furthermore, the metabolism of several agents via cytochrome P450 can cause drug interaction. The importance of quality of life is a major factor with regard to management of therapy. Finally, to date, there is no recommendation of systematic a priori dose reduction in the elderly. In this review we describe the various possibilities of treatment for localized RCC or metastatic RCC in an aging population. Keywords: elderly, kidney cancer, renal cell carcinoma, surgery, targeted therapy, comorbidityhttps://www.dovepress.com/optimal-management-of-renal-cell-carcinoma-in-the-elderly-a-review-peer-reviewed-article-CIAElderlykidney cancerrenal cell carcinomasurgerytargeted therapycomorbidity. |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Quivy A Daste A Harbaoui A Duc S Bernhard JC Gross-Goupil M Ravaud A |
spellingShingle |
Quivy A Daste A Harbaoui A Duc S Bernhard JC Gross-Goupil M Ravaud A Optimal management of renal cell carcinoma in the elderly: a review Clinical Interventions in Aging Elderly kidney cancer renal cell carcinoma surgery targeted therapy comorbidity. |
author_facet |
Quivy A Daste A Harbaoui A Duc S Bernhard JC Gross-Goupil M Ravaud A |
author_sort |
Quivy A |
title |
Optimal management of renal cell carcinoma in the elderly: a review |
title_short |
Optimal management of renal cell carcinoma in the elderly: a review |
title_full |
Optimal management of renal cell carcinoma in the elderly: a review |
title_fullStr |
Optimal management of renal cell carcinoma in the elderly: a review |
title_full_unstemmed |
Optimal management of renal cell carcinoma in the elderly: a review |
title_sort |
optimal management of renal cell carcinoma in the elderly: a review |
publisher |
Dove Medical Press |
series |
Clinical Interventions in Aging |
issn |
1178-1998 |
publishDate |
2013-04-01 |
description |
Amandine Quivy,1,2 Amaury Daste,1 Asma Harbaoui,1 Sophie Duc,2,4 Jean-Christophe Bernhard,2,3 Marine Gross-Goupil,1 Alain Ravaud1,2 1Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France; 2University of Bordeaux 2 (Victor Ségalen), Bordeaux, France; 3Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France; 4Department of Geriatrics, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France Abstract: Both the aging population and the incidence of renal cell carcinoma (RCC) are growing, making the question of tumor management in the elderly a real challenge. Doctors should be aware of the importance of assessing this specific subpopulation. An aggressive therapeutic approach may be balanced by the benefit of the treatment – care or cure – and the life expectancy and willingness of the patient. The treatment for local disease can be surgery (radical or partial nephrectomy) or ablative therapies (radiofrequency, cryotherapy). Even if in most cases surgery is safe, complications such as alteration of renal function may occur, especially in the elderly, with physiological renal impairment at baseline. More recently, another option has been developed as an alternative: active surveillance. In the past decade, new drugs have been approved in the metastatic setting. All the phase 3 trials have included patients without a limit on age. Nevertheless, data concerning the elderly are still poor and concern only a very selective subpopulation. The toxicity profile of targeted agents may interfere with pre-existent comorbidities. Furthermore, the metabolism of several agents via cytochrome P450 can cause drug interaction. The importance of quality of life is a major factor with regard to management of therapy. Finally, to date, there is no recommendation of systematic a priori dose reduction in the elderly. In this review we describe the various possibilities of treatment for localized RCC or metastatic RCC in an aging population. Keywords: elderly, kidney cancer, renal cell carcinoma, surgery, targeted therapy, comorbidity |
topic |
Elderly kidney cancer renal cell carcinoma surgery targeted therapy comorbidity. |
url |
https://www.dovepress.com/optimal-management-of-renal-cell-carcinoma-in-the-elderly-a-review-peer-reviewed-article-CIA |
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