Clinical pharmacology in the adolescent oncology patient

Abstract

Numerous studies have documented that adolescents and young adults (AYAs) experience a significant cancer burden as well as significant cancer mortality compared with other age groups. The reasons for the disparate outcomes of AYAs and other age groups are not completely understood and are likely to be multifactorial, including a range of sociodemographic issues unique to these individuals as well as differences between adolescents, younger pediatric patients, and adults in the pharmacology of anticancer agents. Because adolescence is a period of transition from childhood to early adulthood, numerous physical, physiologic, cognitive, and behavioral changes occur during this time. In this review, we provide an overview of the unique developmental physiology of the adolescent and explain how these factors and the behavioral characteristics of adolescents may affect the pharmacology of anticancer agents in this patient population. Finally, we describe examples of studies that have assessed the relation between drug disposition and age, focusing on the AYA age group.

Fig 1.

Five-year survival rates in adolescents and young adults compared with older and younger patients. The light orange background zone designates the age range of 15 to 29 years. (A) Cancers with survival rates that are lower in adolescents and young adults than in younger and older patients. (B) Cancers with survival rates that are lower in adolescents and young adults than in younger patients. Data adapted. NHL, non-Hodgkin's lymphoma; ALL, acute lymphocytic leukemia.

Fig 2.

Change in 5-year survival rates by age and treatment era. Data adapted. Gray, improvement in survival for patients age 0 to 14 years between 1975 and 1998; light orange, improvement in survival for patients age 15 to 39 years between 1975 and 1998; light blue, improvement in survival for patients older than 40 years between 1975 and 1998.

Fig 3.

During the normal pubertal process, adolescents experience numerous physiologic, physical, and psychosocial changes that can affect drug disposition. BMI, body mass index.

Fig 4.

Relation between developmental changes and chronologic and bone age. Data adapted.