Current Trends in Systemic Therapies in Elderly Patients With Metastatic Colorectal Cancer

Abstract

The incidence of colorectal cancer increases with age and the population is aging, making treatment of elderly patients with metastatic colorectal cancer (mCRC) an increasingly common part of oncology practice. We review the literature regarding systemic treatment of colorectal cancer in the elderly population. Most of the data for toxicity and efficacy of systemic therapies for mCRC in older patients comes from subgroup analysis of pooled phase II and III trials of both chemotherapy and targeted agents. These studies suggest that combination chemotherapy and targeted therapy are well-tolerated in fit elderly patients with slightly increased risk of toxicity. Assessment of functional status independent of age can help differentiate which patients are candidates for combination chemotherapy, single-agent chemotherapy, targeted therapy, or supportive care. Fit, elderly patients should be treated as younger patients. Dose-reduced doublet therapy with dose escalation as tolerated is a safe and effective way to treat less-fit elderly patients. Most targeted therapies appear to be safe in the elderly population without significant concerns for increased toxicity.