Tyrosine Kinase Inhibitors for the Elderly

doi:10.7150/jca.14819

Review

. 2016 Mar 21;7(6):687-93.

doi: 10.7150/jca.14819. eCollection 2016.

Tyrosine Kinase Inhibitors for the Elderly

Wolfgang Hohenforst-Schmidt¹, Paul Zarogoulidis², Michael Steinheimer¹, Naim Benhassen¹, Theodora Tsiouda², Sofia Baka³, Lonny Yarmus⁴, Grigoris Stratakos², John Organtzis², Athanasia Pataka², Kosmas Tsakiridis⁵, Ilias Karapantzos⁶, Chrysanthi Karapantzou⁶, Kaid Darwiche⁷, Athanasios Zissimopoulos⁸, Georgia Pitsiou², Konstantinos Zarogoulidis², Yan-Gao Man⁹, Harald Rittger¹

Affiliations

¹ 1. Medical Clinic I, ''Fuerth'' Hospital, University of Erlangen, Fuerth, Germany.
² 2. Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
³ 3. Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece.
⁴ 4. Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Baltimore, U.S.A.
⁵ 5. Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece.
⁶ 6. Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece.
⁷ 8. Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany.
⁸ 9. Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Thrace, Greece.
⁹ 7. Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA.

PMID: 27076850
PMCID: PMC4829555
DOI: 10.7150/jca.14819

Review

Tyrosine Kinase Inhibitors for the Elderly

Wolfgang Hohenforst-Schmidt et al. J Cancer. 2016.

. 2016 Mar 21;7(6):687-93.

doi: 10.7150/jca.14819. eCollection 2016.

Authors

Affiliations

¹ 1. Medical Clinic I, ''Fuerth'' Hospital, University of Erlangen, Fuerth, Germany.
² 2. Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
³ 3. Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece.
⁴ 4. Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Baltimore, U.S.A.
⁵ 5. Thoracic Surgery Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece.
⁶ 6. Ear, Nose and Throat Department, "Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece.
⁷ 8. Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany.
⁸ 9. Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Thrace, Greece.
⁹ 7. Research Laboratory and International Collaboration, Bon Secours Cancer Institute, VA, USA.

PMID: 27076850
PMCID: PMC4829555
DOI: 10.7150/jca.14819

Abstract

Until few years ago non-specific cytotoxic agents were considered the tip of the arrow as first line treatment for lung cancer. However; age > 75 was considered a major drawback for this kind of therapy. Few exceptions were made by doctors based on the performance status of the patient. The side effects of these agents are still severe for several patients. In the recent years further investigation of the cancer genome has led to targeted therapies. There have been numerous publications regarding novel agents such as; erlotinib, gefitinib and afatinib. In specific populations these agents have demonstrated higher efficiency and this observation is explained by the overexpression of the EGFR pathway in these populations. We suggest that TKIs should administered in the elderly, and with the word elderly we propose the age of 75. The treating medical doctor has to evaluate the performance status of a patient and decide the best treatment in several cases indifferent of the age. TKIs in most studies presented safety and efficiency and of course dose modification should be made when necessary. Comorbidities should be considered in any case especially in this group of patients and the treating physician should act accordingly.

Keywords: afatinib; elderly; erlotinib; gefitinib; targeted therapies.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

**Figure 1**
**EGFR;** Epidermal Growth Factor, **AKT;** kinase-interacting protein1, **PTEN;** Phosphatidylinositol-3,4,5-trisphosphate 3-phosphatase, **PI3K;** Phosphatidylinositol-3-kinases, PI 3-kinases, PI(3)Ks, **RAS;** Ras superfamily of proteins, which are all related in 3D structure and regulate diverse cell behaviours, **RAF;** Raf kinases (more avidly C-Raf than B-Raf), **MAPK/ERK;** extracellular signal-regulated kinases , **TKI;** Tyrosine kinase inhibitor, STAT; Signal Transducers and Activators of Transcription. **MEK;** mitogen-activated protein kinase kinase enzymes MEK1 and/or MEK2.

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References

1. Boffetta P. Epidemiology of environmental and occupational cancer. Oncogene. 2004;23:6392–403. doi:10.1038/sj.onc.1207715. - PubMed
1. Domvri K, Zarogoulidis P, Darwiche K, Browning RF, Li Q, Turner JF. et al. Molecular Targeted Drugs and Biomarkers in NSCLC, the Evolving Role of Individualized Therapy. Journal of Cancer. 2013;4:736–54. doi:10.7150/jca.7734. - PMC - PubMed
1. Zarogoulidis K, Latsios D, Porpodis K, Zarogoulidis P, Darwiche K, Antoniou N. et al. New dilemmas in small-cell lung cancer TNM clinical staging. OncoTargets and therapy. 2013;6:539–47. doi:10.2147/OTT.S44201. - PMC - PubMed
1. Kallianos A, Rapti A, Zarogoulidis P, Tsakiridis K, Mpakas A, Katsikogiannis N. et al. Therapeutic procedure in small cell lung cancer. Journal of thoracic disease. 2013;5(Suppl 4):S420–4. doi:10.3978/j.issn.2072-1439.2013.09.16. - PMC - PubMed
1. Zarogoulidou V, Panagopoulou E, Papakosta D, Petridis D, Porpodis K, Zarogoulidis K. et al. Estimating the direct and indirect costs of lung cancer: a prospective analysis in a Greek University Pulmonary Department. Journal of thoracic disease. 2015;7:S12–9. doi:10.3978/j.issn.2072-1439.2015.01.57. - PMC - PubMed

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[1] Boffetta P. Epidemiology of environmental and occupational cancer. Oncogene. 2004;23:6392–403. doi:10.1038/sj.onc.1207715. - PubMed

[2] Boffetta P. Epidemiology of environmental and occupational cancer. Oncogene. 2004;23:6392–403. doi:10.1038/sj.onc.1207715. - PubMed

[3] Domvri K, Zarogoulidis P, Darwiche K, Browning RF, Li Q, Turner JF. et al. Molecular Targeted Drugs and Biomarkers in NSCLC, the Evolving Role of Individualized Therapy. Journal of Cancer. 2013;4:736–54. doi:10.7150/jca.7734. - PMC - PubMed

[4] Domvri K, Zarogoulidis P, Darwiche K, Browning RF, Li Q, Turner JF. et al. Molecular Targeted Drugs and Biomarkers in NSCLC, the Evolving Role of Individualized Therapy. Journal of Cancer. 2013;4:736–54. doi:10.7150/jca.7734. - PMC - PubMed

[5] Zarogoulidis K, Latsios D, Porpodis K, Zarogoulidis P, Darwiche K, Antoniou N. et al. New dilemmas in small-cell lung cancer TNM clinical staging. OncoTargets and therapy. 2013;6:539–47. doi:10.2147/OTT.S44201. - PMC - PubMed

[6] Zarogoulidis K, Latsios D, Porpodis K, Zarogoulidis P, Darwiche K, Antoniou N. et al. New dilemmas in small-cell lung cancer TNM clinical staging. OncoTargets and therapy. 2013;6:539–47. doi:10.2147/OTT.S44201. - PMC - PubMed

[7] Kallianos A, Rapti A, Zarogoulidis P, Tsakiridis K, Mpakas A, Katsikogiannis N. et al. Therapeutic procedure in small cell lung cancer. Journal of thoracic disease. 2013;5(Suppl 4):S420–4. doi:10.3978/j.issn.2072-1439.2013.09.16. - PMC - PubMed

[8] Kallianos A, Rapti A, Zarogoulidis P, Tsakiridis K, Mpakas A, Katsikogiannis N. et al. Therapeutic procedure in small cell lung cancer. Journal of thoracic disease. 2013;5(Suppl 4):S420–4. doi:10.3978/j.issn.2072-1439.2013.09.16. - PMC - PubMed

[9] Zarogoulidou V, Panagopoulou E, Papakosta D, Petridis D, Porpodis K, Zarogoulidis K. et al. Estimating the direct and indirect costs of lung cancer: a prospective analysis in a Greek University Pulmonary Department. Journal of thoracic disease. 2015;7:S12–9. doi:10.3978/j.issn.2072-1439.2015.01.57. - PMC - PubMed

[10] Zarogoulidou V, Panagopoulou E, Papakosta D, Petridis D, Porpodis K, Zarogoulidis K. et al. Estimating the direct and indirect costs of lung cancer: a prospective analysis in a Greek University Pulmonary Department. Journal of thoracic disease. 2015;7:S12–9. doi:10.3978/j.issn.2072-1439.2015.01.57. - PMC - PubMed

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Tyrosine Kinase Inhibitors for the Elderly

Affiliations

Tyrosine Kinase Inhibitors for the Elderly

Authors

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Abstract

Conflict of interest statement

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