[Chemotherapy in the elderly patient]. / I trattamenti chemioterapici nel paziente anziano.

In the past, the clinical approach in elderly cancer patients was different than in younger ones; the natural history of neoplastic disease and the chemotherapy-related toxicity were the main reasons for this behaviour, and frequently over 65 years patients were excluded from chemotherapeutic treatments and from clinical trials. In the last years, according to clinical data, this approach changed and now there is evidence that also old patients (70-80 ys) can be treated with full dose chemotherapy, on condition that no poor performance status and no severe associated disease are present. Nevertheless, because of the increasing number of cancer patients with advanced age, in future it will be necessary to optimize the antineoplastic treatments individualizing chemotherapy and improving the clinical surveillance in this subset of patients. Moreover it will be strategic to identify optimal schedules of treatment in elderly cancer patients.

[Chemotherapy in gastroenterologic neuroendocrine tumors]. / Chemioterapia nei tumori neuroendocrini gastroenterici.

Gastrointestinal neuroendocrine tumors (carcinoids tumors and endocrine islet cell tumors) are a family of rare malignancies with many typical characteristics by a biologic, epidemiologic and clinical point of view. In this category of neoplasia an integrated clinical and therapeutic approach is mandatory, whereas for too many years these tumors were investigated and treated in an empirical way without considering an integrated approach. The singular features of this class of malignancies, with different and complex symptomatology, with enigmatic clinical presentation and outcome and with conflicting therapeutic options, oblige the clinicians to give different treatment to the patients. Chemotherapy has a marginal role in gastrointestinal neuroendocrine tumors mostly because it is used in patients with advanced disease not suitable for other therapeutic approach (surgery, thermoablation, chemoembolization, biotherapy). Unfortunately in the past it was not possible to establish the efficacy of chemotherapy in these malignancies because most of the studies pooled without distinction carcinoids, pancreatic tumors and hepatic metastases from unknown primary. The most extensively studied drugs have been streptozotocin, doxorubicin, mitoxantrone, dacarbazine, used alone or in combination; the gold standard today is considered the association of streptozotocin with doxorubicin or 5-fluorouracil, but there is strong evidence that the disappointing results in the treatment of these rare malignancies could be improved in a multidisciplinary fashion; in this field the combination of new drugs with aggressive surgery, radionuclide therapy, biotherapy and local therapeutic approach will give new opportunities to better control the symptoms and the clinical course of gastrointestinal neuroendocrine tumors.