• Home
• CME test
• CME information and faculty disclosures
• Select publications
• Related audio program

DR QUINN: I think it’s a question as to how you define a geriatric. I have 90-year-olds that are the new 60. But I have 60-year-olds that may as well be 100. The issue in the studies is, we screen the patients out. We want the ECOG 0 and 1 or similar Karnofsky scale. The intersection between performance status and age, I think, is very important.

When I look at a patient who I’m thinking, “Hmmm, are you a geriatric?” I often think whether they’re thinking the same thing about me, but I’m also thinking, “There’s a crucial period where we’re going to treat you.” I know from the geriatric studies that the first 8 to 12 weeks are crucial. There’ll be maximal side effects from the VEGF TKIs, and maybe we need to individualize the approach — see them more often because they will not call you if they’re sick and in bed. They’ll just stop their drug or they’ll end up going somewhere else. Their access back to us is a little bit more of a challenge. I think that’s a really important issue.

DR LOVE: Interesting. Walter, any thoughts about this case?

DR STADLER: I think that there’s a couple of issues. One is that we have to be a little bit careful with some of our older individuals, especially patients who may have a different physiology. I think we have to individualize doses.

The other thing, though, I think that’s important here is this balance of adjusting appropriately for patients who may be a little bit older but not practicing ageism because we have patients who are in their seventies and eighties who are in good shape who are otherwise good candidates for treatment. And we should treat them, and we should treat them appropriately.