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Gastrointestinal Cancer

Chemotherapy in Elderly Patients with Colorectal Cancer

^aKlinik für Onkologie/Hämatologie, Klinikum Oldenburg, Oldenburg, Germany; ^bUniversity Hospital "Carl Gustav Carus," Medical Department I, Dresden, Germany; ^cUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; ^dHôpital Amboise Paré, Paris, France

Key Words. Colorectal • Chemotherapy • Geriatric assessment • Irinotecan • Targeted therapy

Correspondence: Claus-Henning Köhne, M.D., Klinik für Onkologie/Hämatologie, Klinikum Oldenburg, Dr.-Eden-Str. 10, 26133 Oldenburg, Germany. Telephone: 49-441-403-2611; Fax: 49-441-403-2654; e-mail: onkologie{at}klinikum-oldenburg.de

Disclosure: G.F. has received compensation from Merck KGaA, Pfizer, and Sanofi-Aventis, and has contracted research from Merck KGaA and Pfizer. R.M.G. has acted as a consultant to and received honoraria from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, ImClone, Pfizer, Sanofi-Aventis, Taiho, and Yakult Honsha. E.M. has acted as a consultant to Pfizer and Roche. P.R. has acted as a consultant to Pfizer, Sanofi-Aventis, and Merck. No other potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

Significant advancements in chemotherapy for metastatic colorectal cancer (mCRC) have been achieved over the past decade, and the median overall survival duration is now close to 24 months with appropriate treatment. The most widely recommended chemotherapy regimens are based on the use of irinotecan or oxaliplatin in combination with 5-fluorouracil and leucovorin; some data suggest further benefit with the addition of the targeted agents bevacizumab or cetuximab. Colorectal cancer primarily affects the elderly; however, much of the defining clinical research in this field has excluded subjects of advanced age or with a poor performance status, making it difficult for clinicians to interpret current treatment paradigms for their older patients. Most clinical trials that have included elderly patients document similar survival rates and toxicity profiles to those seen in younger patients. Moreover, survey data suggest that >70% of elderly patients with cancer are willing to undergo strong, palliative chemotherapy. While these findings suggest that age itself should not determine candidacy for chemotherapy, it is important to note the great heterogeneity of the elderly population with regard to overall health, independence, and performance status. The use of a comprehensive geriatric assessment is recommended to evaluate chemotherapy appropriateness. The management of frail elderly patients and those with a short life expectancy should be focused on palliation, while fit elderly patients can receive aggressive therapy in a similar fashion to younger patients.