Hematopoietic toxicity of most drugs and of radiation therapy is increased to some degree. Gastrointestinal toxicities of 5-fluorouracil and doxorubicin may be increased, and frail patients are less able to tolerate short episodes of diarrhea or decreased oral intake from mucositis. Reduced cardiac reserve makes it more difficult for the elderly to tolerate anthracyclines, and decreased renal reserve decreases tolerance to platinum drugs and methotrexate, requiring adjustments in dose or choice of drug. With curable malignancies, great care must be taken not to reduce doses without documented need. Advancements in hematologic manipulation have made the use of chemotherapy safer in the elderly.
Erythropoietin is often effective in treating chemotherapy-induced anemia and is well tolerated.
Oprelvekin, a nonspecific growth factor for megakaryocytes, has been approved for preventing and treating severe thrombocytopenia associated with chemotherapy. It should be used with caution in patients at risk of heart failure or with central nervous system tumors. Pamidronate is effective treatment of tumor-induced hypercalcemia. Other bisphosphonates may be as effective. Dolasetron may cause a prolonged QT interval and therefore must be used with caution in patients at risk of ventricular arrhythmias.