Chemotherapy for colorectal cancer in the elderly

• Published in: World journal of gastroenterology : WJG Vol. 21; no. 17; pp. 5158 - 5166
• Main Author: Kim, Jung Han
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 07.05.2015
• Subjects: Adjuvant; Age Factors; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; cancer;Elderly; chemotherapy; Chemotherapy, Adjuvant; Colorectal; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Geriatric Assessment; Humans; Molecular Targeted Therapy; Neoplasm Staging; Palliative; Palliative Care; Patient Selection; Predictive Value of Tests; Review; Risk Factors; Topic Highlight; Treatment Outcome; Adjuvant chemotherapy; Review; Elderly; Colorectal cancer; Palliative chemotherapy
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i17.5158

Colorectal cancer （CRC） is one of the leading causesof cancer-related death in the elderly. However,elderly patients with CRC tend to be under-presentedin clinical trials and undertreated in clinical practice.Advanced age alone should not be the only criteria topreclude effective therapy in elderly patients with CRC.The best guide about optimal cancer treatment canbe provided by comprehensive geriatric assessment.Elderly patients with stage Ⅲ colon cancer can enjoythe same benefit from adjuvant chemotherapy with 5-fluorouracil/leucovorin or capecitabine as youngerpatients, without a substantial increase in toxicity. Withconflicting results of retrospective studies and a lackof data available from randomized studies, combinedmodality treatment should be used with great cautionin elderly patients with locally advanced rectal cancer.Combination chemotherapy can be considered for olderpatients with metastatic CRC. For elderly patients whoare frail or vulnerable, however, monotherapy or a stopand-go strategy may be desirable. The use of targetedtherapies in older patients with metastatic CRC appearsto be promising in view of their better efficacy andtoxicity. Treatment should be individualized based onthe nature of the disease, the physiologic or functionalstatus, and the patient＇s preference.