Factors influencing the choice of 5-HT3-receptor antagonist antiemetics: focus on elderly cancer patients.

With old age comes declining organ function, cognitive impairment, increased likelihood of comorbid conditions and multiple prescription and nonprescription pharmacotherapy. These issues are particularly relevant in elderly cancer patients, who commonly receive combination chemotherapy and supportive care agents along with radiation therapy and surgery. This situation can complicate medical care, particularly since over half of all cancers occur in those aged over 65 years. The 5-HT(3)-receptor antagonists as a class are highly effective antiemetics and are currently considered the gold standard for treatment of chemotherapy- and radiotherapy-induced nausea and vomiting. However, these agents do possess different pharmacologic properties, such as varying terminal half lives, routes of metabolism and selectivity for 5-HT(3) receptors. These differences may have an impact on efficacy (e.g., duration of action of the drug) safety (e.g., the risk of drug interactions and potential adverse effects), and simplicity of the dosing regimen. The focus of this review is on some of the pertinent issues of 5-HT(3) antagonists relating to elderly cancer patients.