Oral Chemotherapy for the Older Patient with Cancer

Oral chemotherapy presents a number of theoretical advantages in older cancer patients, including convenience of administration and dosage flexibility. Of the oral fluorinated pyrimidines, capecitabine is the most promising, because it minimizes the exposure of normal tissue to the active drug and substantially reduces the risk of mucositis, that is particularly common and severe in the aged. Despite promising initial results, oral etoposide does not offer any special advantage over the intravenous formulation for older patients, while oral temozolomide may have a role in the palliation of malignant melanoma and primary and secondary brain tumors. Of the experimental agents, oral platinum (satraplatin) and oral taxane formulations appear to be the most promising for minimization of the toxicity of the corresponding intravenous drug. Of special interest are tumor-specific agents, including inhibitors of tyrosine phosphokinase (e.g. imatinib mesylate) and angiogenesis. In conclusion, oral chemotherapy of cancer appears to be a very promising option for older patients.