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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Autores principales:	Quivy A, Daste A, Harbaoui A, Duc S, Bernhard JC, Gross-Goupil M, Ravaud A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Elderly kidney cancer renal cell carcinoma surgery targeted therapy comorbidity. Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/168e8bb7ac2944858bb611e80520faad
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spelling	oai:doaj.org-article:168e8bb7ac2944858bb611e80520faad2021-12-02T11:43:47ZOptimal management of renal cell carcinoma in the elderly: a review1178-1998https://doaj.org/article/168e8bb7ac2944858bb611e80520faad2013-04-01T00:00:00Zhttps://www.dovepress.com/optimal-management-of-renal-cell-carcinoma-in-the-elderly-a-review-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Amandine 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, comorbidityQuivy ADaste AHarbaoui ADuc SBernhard JCGross-Goupil MRavaud ADove Medical PressarticleElderlykidney cancerrenal cell carcinomasurgerytargeted therapycomorbidity.GeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 8, Pp 433-442 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Elderly kidney cancer renal cell carcinoma surgery targeted therapy comorbidity. Geriatrics RC952-954.6
spellingShingle	Elderly kidney cancer renal cell carcinoma surgery targeted therapy comorbidity. Geriatrics RC952-954.6 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
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
format	article
author	Quivy A Daste A Harbaoui A Duc S Bernhard JC Gross-Goupil M Ravaud A
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
publishDate	2013
url	https://doaj.org/article/168e8bb7ac2944858bb611e80520faad
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Optimal management of renal cell carcinoma in the elderly: a review

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