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Guidance for Treating the Older Adults with Colorectal Cancer

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Opinion statement

The need for evidence-based data in the rapidly growing group of older patients is vast and more elderly-specific studies are desperately needed, for which there is clear demand from both patients and providers. Notably, many of the studies discussed in this review included unplanned subset analyses based on age and/or were not originally stratified by age; therefore, these data, particularly overall survival data, need to be interpreted with some caution as they may not be statistically valid based on the initial trial design and statistical plan. As we await data from ongoing elderly-specific trials, our recommendation for managing older patients with CRC should include geriatric screening tools (e.g., CSGA, VES-13, G8, CARG, CRASH) to help guide treatment adjustments for improved tolerability without sacrificing efficacy. For patients with a positive screen for significant geriatric concerns, a full geriatric assessment is recommended to guide treatment approach and supportive care. Prior data support the use of all approved medications for CRC in older adults who are fit; however, treatment breaks and dose attenuation with potential escalation are reasonable options for these patients. Ultimately, management decisions in the care of older adults with mCRC must be made through shared decision-making with the patient with consideration for the patient’s functional status, comorbidities, goals of care, social support, as well as potential toxicities and possible effect on QoL.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin 2022;72(1):7–33. https://doi.org/10.3322/caac.21708.

  2. Surveillance E, and End Results (SEER) Program. Cancer Stat Facts: Colorectal Cancer. https://seer.cancer.gov/statfacts/html/colorect.html. Accessed 9/10/2022.

  3. Siegel RL, Miller KD, Goding Sauer A et al. Colorectal cancer statistics, 2020. CA Cancer J Clin 2020;70(3):145–164. https://doi.org/10.3322/caac.21601.

  4. Sung H, Ferlay J, Siegel RL et al. Global cancer statistics 2020: GLOBOCAN Estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209–249. https://doi.org/10.3322/caac.21660.

  5. Vincent G, Velkoff V. The next four decades: the older population in the United States - 2010 to 2050: Population estimates and projections. . U.S. Census Bureau, May 2010.

  6. U.S. Census Bureau. 2012-2016 American Community Survey 5-Year Estimates. https://www.census.gov/programs-surveys/acs/technical-documentation/table-and-geography-changes/2016/5-year.html. Accessed 9/9/2022.

  7. Desantis CE, Miller KD, Dale W et al. Cancer statistics for adults aged 85 years and older, 2019. CA Cancer J Clin 2019;69(6):452–467. https://doi.org/10.3322/caac.21577.

  8. SEER Cancer Stat Facts: Colorectal Cancer. National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/statfacts/html/colorect.html. Accessed 9/10/2022.

  9. Walter V, Boakye D, Weberpals J, et al. Decreasing use of chemotherapy in older patients with stage III colon cancer irrespective of comorbidities. J Nat Compr Cancer Netw. 2019;17(9):1089–99. https://doi.org/10.6004/jnccn.2019.7287.

    Article  CAS  Google Scholar 

  10. Chang HJ, Lee KW, Kim JH, et al. Adjuvant capecitabine chemotherapy using a tailored-dose strategy in elderly patients with colon cancer. Ann Oncol. 2012;23(4):911–8. https://doi.org/10.1093/annonc/mdr329.

    Article  CAS  PubMed  Google Scholar 

  11. Antonio M, Carmona-Bayonas A, Saldana J et al. Factors Predicting Adherence to a Tailored-Dose Adjuvant Treatment on the Basis of Geriatric Assessment in Elderly People With Colorectal Cancer: A Prospective Study. Clin Colorectal Cancer 2018;17(1):e59-e68. https://doi.org/10.1016/j.clcc.2017.09.003. Well-designed elderly-specific trial with a good review of geriatric assessment.

  12. Lund CM, Vistisen KK, Olsen AP, et al. The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO). Br J Cancer. 2021;124(12):1949–58. https://doi.org/10.1038/s41416-021-01367-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Francois E, Pernot M, Ronchin P et al. NACRE: A randomized study comparing short course radiotherapy with radiochemotherapy for locally advanced rectal cancers in the elderly—Preliminary results. J Clin Oncol 2021;39(3_suppl):4–4. https://doi.org/10.1200/JCO.2021.39.3_suppl.4. Elderly-specific rectal cancer trial.

  14. Seymour MT, Thompson LC, Wasan HS, et al. Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): an open-label, randomised factorial trial. Lancet. 2011;377(9779):1749–59. https://doi.org/10.1016/s0140-6736(11)60399-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Aparicio T, Lavau-Denes S, Phelip JM, et al. Randomized phase III trial in elderly patients comparing LV5FU2 with or without irinotecan for first-line treatment of metastatic colorectal cancer (FFCD 2001–02). Ann Oncol. 2016;27(1):121–7. https://doi.org/10.1093/annonc/mdv491.

    Article  CAS  PubMed  Google Scholar 

  16. Cunningham D, Lang I, Marcuello E, et al. Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): an open-label, randomised phase 3 trial. Lancet Oncol. 2013;14(11):1077–85. https://doi.org/10.1016/S1470-2045(13)70154-2.

    Article  CAS  PubMed  Google Scholar 

  17. Hamaguchi T, Takashima A, Mizusawa J et al. A randomized phase III trial of mFOLFOX7 or CapeOX plus bevacizumab versus 5-FU/l-LV or capecitabine plus bevacizumab as initial therapy in elderly patients with metastatic colorectal cancer: JCOG1018 study (RESPECT). J Clin Oncol 2022;40(4_suppl):10–10. https://doi.org/10.1200/JCO.2022.40.4_suppl.010.

  18. Lonardi S, Schirripa M, Buggin F et al. First-line FOLFOX plus panitumumab versus 5FU plus panitumumab in RAS-BRAF wild-type metastatic colorectal cancer elderly patients: The PANDA study. J Clin Oncol 2020;38(15_suppl):4002–4002. https://doi.org/10.1200/JCO.2020.38.15_suppl.4002.

  19. Petrioli R, Chirra M, Messuti L, et al. Efficacy and safety of regorafenib with 2/1 schedule for patients ≥ 75 years with metastatic colorectal cancer (mCRC) after failure of 2 lines of chemotherapy. Clin Colorec Cancer. 2018;17(4):307–12. https://doi.org/10.1016/j.clcc.2018.02.005.

    Article  Google Scholar 

  20. Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346(14):1061–6. https://doi.org/10.1056/NEJMsa012528.

    Article  PubMed  Google Scholar 

  21. Paillaud E, Caillet P, Laurent M et al. Optimal management of elderly cancer patients: usefulness of the comprehensive geriatric assessment. Clin Interven Aging. 2014:1645. https://doi.org/10.2147/cia.s57849.

  22. Chaibi P, Magne N, Breton S, et al. Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients. Crit Rev Oncol Hematol. 2011;79(3):302–7. https://doi.org/10.1016/j.critrevonc.2010.08.004.

    Article  PubMed  Google Scholar 

  23. Kalsi T, Babic-Illman G, Ross PJ, et al. The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people. Br J Cancer. 2015;112(9):1435–44. https://doi.org/10.1038/bjc.2015.120.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Li D, Sun CL, Kim H et al. Geriatric Assessment-Driven Intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: a randomized clinical trial. JAMA Oncol 2021;7(11):e214158. https://doi.org/10.1001/jamaoncol.2021.4158. Trial demonstrating the feasibility of geriatric assessment-guided therapy and subsequently improved patient outcomes.

  25. Mohile SG, Mohamed MR, Xu H et al. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet 2021;398(10314):1894–1904. https://doi.org/10.1016/S0140-6736(21)01789-X. Trial demonstrating the feasibility of geriatric assessment-guided therapy and subsequently improved patient outcomes.

  26. Kalsi T, Babic-Illman G, Ross PJ, et al. The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people. Br J Cancer. 2015;112(9):1435–44. https://doi.org/10.1038/bjc.2015.120.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Dotan E, Walter LC, Browner IS et al. NCCN Guidelines® Insights: Older Adult Oncology, Version 1.2021. J Nat Compr Cancer Netw 2021;19(9):1006–1019. https://doi.org/10.6004/jnccn.2021.0043.

  28. Mohile SG, Dale W, Somerfield MR, et al. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol. 2018;36(22):2326–47. https://doi.org/10.1200/jco.2018.78.8687.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Caillet P, Laurent M, Bastuji-Garin S, et al. Optimal management of elderly cancer patients: usefulness of the comprehensive geriatric assessment. Clin Interv Aging. 2014;9:1645–60. https://doi.org/10.2147/CIA.S57849.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Basso U, Falci C, Brunello A et al. Prognostic value of multidimensional geriatric assessment (MGA) on survival of a prospective cohort of 880 elderly cancer patients (ECP). J Clin Oncol 2011;29(15_suppl):9065–9065. https://doi.org/10.1200/jco.2011.29.15_suppl.9065.

  31. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department–the DEED II study. J Am Geriatr Soc. 2004;52(9):1417–23. https://doi.org/10.1111/j.1532-5415.2004.52401.x.

    Article  PubMed  Google Scholar 

  32. Ellis G, Gardner M, Tsiachristas A, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 2017;9:CD006211. https://doi.org/10.1002/14651858.CD006211.pub3.

  33. Frese T, Deutsch T, Keyser M, Sandholzer H. In-home preventive comprehensive geriatric assessment (CGA) reduces mortality–a randomized controlled trial. Arch Gerontol Geriatr. 2012;55(3):639–44. https://doi.org/10.1016/j.archger.2012.06.012.

    Article  PubMed  Google Scholar 

  34. Mohile SG, Velarde C, Hurria A, et al. Geriatric assessment-guided care processes for older adults: a delphi consensus of geriatric oncology experts. J Natl Compr Canc Netw. 2015;13(9):1120–30. https://doi.org/10.6004/jnccn.2015.0137.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457–65. https://doi.org/10.1200/JCO.2011.34.7625.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 2007;25(14):1824–31. https://doi.org/10.1200/JCO.2007.10.6559.

    Article  PubMed  Google Scholar 

  37. Hurria A, Gupta S, Zauderer M, et al. Developing a cancer-specific geriatric assessment: a feasibility study. Cancer. 2005;104(9):1998–2005. https://doi.org/10.1002/cncr.21422.

    Article  PubMed  Google Scholar 

  38. Hurria A, Cirrincione CT, Muss HB, et al. Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401. J Clin Oncol. 2011;29(10):1290–6. https://doi.org/10.1200/JCO.2010.30.6985.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Saliba D, Elliott M, Rubenstein LZ, et al. The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;49(12):1691–9. https://doi.org/10.1046/j.1532-5415.2001.49281.x.

    Article  CAS  PubMed  Google Scholar 

  40. Bellera CA, Rainfray M, Mathoulin-Pelissier S, et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;23(8):2166–72. https://doi.org/10.1093/annonc/mdr587.

    Article  CAS  PubMed  Google Scholar 

  41. Hurria A, Mohile S, Gajra A, et al. Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol. 2016;34(20):2366–71. https://doi.org/10.1200/jco.2015.65.4327.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118(13):3377–86. https://doi.org/10.1002/cncr.26646.

    Article  PubMed  Google Scholar 

  43. Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist. 2000;5(3):224–37. https://doi.org/10.1634/theoncologist.5-3-224.

    Article  CAS  PubMed  Google Scholar 

  44. Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Lancet 1995;345(8955):939–44. https://www.ncbi.nlm.nih.gov/pubmed/7715291. Accessed 9/10/2022.

  45. O’Connell MJ, Laurie JA, Kahn M, et al. Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer. J Clin Oncol. 1998;16(1):295–300. https://doi.org/10.1200/JCO.1998.16.1.295.

    Article  CAS  PubMed  Google Scholar 

  46. Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators. J Clin Oncol 1999;17(5):1356–63. https://www.ncbi.nlm.nih.gov/pubmed/10334519. Accessed 9/10/2022.

  47. Sargent DJ, Goldberg RM, Jacobson SD, et al. A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Eng J Med. 2001;345(15):1091–7. https://doi.org/10.1056/nejmoa010957.

    Article  CAS  Google Scholar 

  48. André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Eng J Med. 2004;350(23):2343–51. https://doi.org/10.1056/nejmoa032709.

    Article  Google Scholar 

  49. André T, Boni C, Navarro M, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol. 2009;27(19):3109–16. https://doi.org/10.1200/jco.2008.20.6771.

    Article  PubMed  Google Scholar 

  50. Tournigand C, André T, Bonnetain F, et al. Adjuvant therapy with fluorouracil and oxaliplatin in stage II and elderly patients (between ages 70 and 75 years) with colon cancer: subgroup analyses of the multicenter international study of oxaliplatin, fluorouracil, and leucovorin in the adjuvant Tre. J Clin Oncol. 2012;30(27):3353–60. https://doi.org/10.1200/jco.2012.42.5645.

    Article  CAS  PubMed  Google Scholar 

  51. André T, De Gramont A, Vernerey D, et al. Adjuvant fluorouracil, leucovorin, and oxaliplatin in stage ii to iii colon cancer: updated 10-year survival and outcomes according to <i>BRAF</i> mutation and mismatch repair status of the MOSAIC study. J Clin Oncol. 2015;33(35):4176–87. https://doi.org/10.1200/jco.2015.63.4238.

    Article  PubMed  Google Scholar 

  52. Haller DG, Cassidy J, Tabernero J, et al. Efficacy findings from a randomized phase III trial of capecitabine plus oxaliplatin versus bolus 5-FU/LV for stage III colon cancer (NO16968): Impact of age on disease-free survival (DFS). J Clin Oncol 2010;28(15_suppl):3521–3521. https://doi.org/10.1200/jco.2010.28.15_suppl.3521.

  53. Schmoll H-J, Tabernero J, Maroun J, et al. Capecitabine plus oxaliplatin compared with fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: final results of the NO16968 randomized controlled phase III trial. J Clin Oncol. 2015;33(32):3733–40. https://doi.org/10.1200/jco.2015.60.9107.

    Article  CAS  PubMed  Google Scholar 

  54. Sanoff HK, Carpenter WR, Stürmer T, et al. Effect of adjuvant chemotherapy on survival of patients with stage III colon cancer diagnosed after age 75 years. J Clin Oncol. 2012;30(21):2624–34. https://doi.org/10.1200/jco.2011.41.1140.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Sanoff HK, Carpenter WR, Freburger J, et al. Comparison of adverse events during 5-fluorouracil versus 5-fluorouracil/oxaliplatin adjuvant chemotherapy for stage III colon cancer. Cancer. 2012;118(17):4309–20. https://doi.org/10.1002/cncr.27422.

    Article  CAS  PubMed  Google Scholar 

  56. Yothers G, O’Connell MJ, Allegra CJ, et al. Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses. J Clin Oncol. 2011;29(28):3768–74. https://doi.org/10.1200/jco.2011.36.4539.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Haller DG, O’Connell MJ, Cartwright TH, et al. Impact of age and medical comorbidity on adjuvant treatment outcomes for stage III colon cancer: a pooled analysis of individual patient data from four randomized, controlled trials. Ann Oncol. 2015;26(4):715–24. https://doi.org/10.1093/annonc/mdv003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Abrams TA, Brightly R, Mao J, et al. Patterns of adjuvant chemotherapy use in a population-based cohort of patients with resected stage II or III colon cancer. J Clin Oncol. 2011;29(24):3255–62. https://doi.org/10.1200/jco.2011.35.0058.

    Article  PubMed  Google Scholar 

  59. Kahn KL. Adjuvant chemotherapy use and adverse events among older patients with stage III colon cancer. JAMA. 2010;303(11):1037. https://doi.org/10.1001/jama.2010.272.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Grothey A, Sobrero AF, Shields AF, et al. Duration of adjuvant chemotherapy for stage III colon cancer. N Eng J Med. 2018;378(13):1177–88. https://doi.org/10.1056/nejmoa1713709.

    Article  CAS  Google Scholar 

  61. Andre T, Meyerhardt J, Iveson T, et al. Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials. Lancet Oncol. 2020;21(12):1620–9. https://doi.org/10.1016/S1470-2045(20)30527-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Rosati G, Galli F, Lonardi S, et al. 399O Oxaliplatin plus fluoropyrimidines as adjuvant therapy for colon cancer in elderly patients: a subgroup analysis from TOSCA trial. Ann Oncol. 2020;31:S410–1. https://doi.org/10.1016/j.annonc.2020.08.510.

    Article  Google Scholar 

  63. van Erning FN, Razenberg LG, Lemmens VE, et al. Intensity of adjuvant chemotherapy regimens and grade III-V toxicities among elderly stage III colon cancer patients. Eur J Cancer. 2016;61:1–10. https://doi.org/10.1016/j.ejca.2016.03.074.

    Article  CAS  PubMed  Google Scholar 

  64. Ho J, Gill S, Woods R, Kennecke HF. Association of survival outcomes with dose intensity of adjuvant therapy (AT) with capecitabine for colorectal cancer (CRC). J Clin Oncol 2010;28(15_suppl):3624–3624. https://doi.org/10.1200/jco.2010.28.15_suppl.3624.

  65. MacLaughlin EJ, Raehl CL, Treadway AK, Sterling TL, Zoller DP, Bond CA. Assessing medication adherence in the elderly: which tools to use in clinical practice? Drugs Aging. 2005;22(3):231–55. https://doi.org/10.2165/00002512-200522030-00005.

    Article  PubMed  Google Scholar 

  66. Antonio M, Saldaña J, Carmona-Bayonas A, et al. Geriatric assessment predicts survival and competing mortality in elderly patients with early colorectal cancer: can it help in adjuvant therapy decision-making? Oncologist. 2017;22(8):934–43. https://doi.org/10.1634/theoncologist.2016-0462.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Batra A, Rigo R, Sheka D, Cheung WY. Real-world evidence on adjuvant chemotherapy in older adults with stage II/III colon cancer. World J Gastroint Oncol. 2020;12(6):604–18. https://doi.org/10.4251/wjgo.v12.i6.604.

    Article  Google Scholar 

  68. Khalil L, Gao X, Switchenko JM, et al. Survival outcomes of adjuvant chemotherapy in elderly patients with stage III colon cancer. Oncologist. 2022;27(9):740–50. https://doi.org/10.1093/oncolo/oyac082.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Chen X, Tu J, Xu X et al. Adjuvant chemotherapy benefit in elderly stage II/III colon cancer patients. Front Oncol 2022;12:874749. https://doi.org/10.3389/fonc.2022.874749.

  70. Swedish Rectal Cancer Trial; Cedermark B, Dahlberg M, Glimelius B, Påhlman L, Rutqvist LE, Wilking N. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336(14):980–7. https://doi.org/10.1056/NEJM199704033361402. Erratum in: N Engl J Med 1997;336(21):1539.

  71. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40. https://doi.org/10.1056/NEJMoa040694.

    Article  CAS  PubMed  Google Scholar 

  72. Shahir MA, Lemmens VE, van de Poll-Franse LV, Voogd AC, Martijn H, Janssen-Heijnen ML. Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: a population-based study. Eur J Cancer. 2006;42(17):3015–21. https://doi.org/10.1016/j.ejca.2005.10.032.

    Article  CAS  PubMed  Google Scholar 

  73. Guillerme F, Clavier JB, Nehme-Schuster H, et al. Age impacts the pattern of care for elderly patients with rectal cancer. Int J Colorect Dis. 2014;29(2):157–63. https://doi.org/10.1007/s00384-013-1778-6.

    Article  Google Scholar 

  74. Chang GJ, Skibber JM, Feig BW, Rodriguez-Bigas M. Are we undertreating rectal cancer in the elderly? An epidemiologic study. Ann Surg 2007;246(2):215-21. https://doi.org/10.1097/SLA.0b013e318070838f.

  75. Aparicio T, Navazesh A, Boutron I, et al. Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment. Crit Rev Oncol Hematol. 2009;71(3):249–57. https://doi.org/10.1016/j.critrevonc.2008.11.006.

    Article  PubMed  Google Scholar 

  76. Lemmens VE, Janssen-Heijnen ML, Verheij CD, Houterman S, Repelaer van Driel OJ, Coebergh JW. Co-morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer. Br J Surg 2005;92(5):615–23. https://doi.org/10.1002/bjs.4913.

  77. Thiels CA, Bergquist JR, Meyers AJ, et al. Outcomes with multimodal therapy for elderly patients with rectal cancer. Br J Surg. 2016;103(2):e106-14. https://doi.org/10.1002/bjs.10057.

    Article  CAS  PubMed  Google Scholar 

  78. Jiang DM, Raissouni S, Mercer J, et al. Clinical outcomes of elderly patients receiving neoadjuvant chemoradiation for locally advanced rectal cancer. Ann Oncol. 2015;26(10):2102–6. https://doi.org/10.1093/annonc/mdv331.

    Article  CAS  PubMed  Google Scholar 

  79. Garcia-Aguilar J, Renfro LA, Chow OS, et al. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015;16(15):1537–46. https://doi.org/10.1016/s1470-2045(15)00215-6.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Ma B, Gao P, Song Y et al. Short-Course Radiotherapy in Neoadjuvant Treatment for Rectal Cancer: A Systematic Review and Meta-analysis. Clin Colorectal Cancer 2018;17(4):320–330 e5. https://doi.org/10.1016/j.clcc.2018.07.014.

  81. Gilbert A, Homer V, Brock K, et al. Quality-of-life outcomes in older patients with early-stage rectal cancer receiving organ-preserving treatment with hypofractionated short-course radiotherapy followed by transanal endoscopic microsurgery (TREC): non-randomised registry of patients unsuit. Lancet Health Longev. 2022. https://doi.org/10.1016/s2666-7568(22)00239-2.

    Article  Google Scholar 

  82. Hathout L, Maloney-Patel N, Malhotra U et al. Management of locally advanced rectal cancer in the elderly: a critical review and algorithm. J Gastrointest Oncol 2018;9(2):363–376. https://doi.org/10.21037/jgo.2017.10.10.

  83. Podda M, Sylla P, Baiocchi G et al. Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technolog. World J Emerg Surg 2021;16(1). https://doi.org/10.1186/s13017-021-00378-9.

  84. Garcia-Aguilar J, Patil S, Gollub MJ, et al. Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy. J Clin Oncol. 2022;40(23):2546–56. https://doi.org/10.1200/jco.22.00032.

    Article  CAS  PubMed  Google Scholar 

  85. Conroy T, Bosset J-F, Etienne P-L, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(5):702–15. https://doi.org/10.1016/s1470-2045(21)00079-6.

    Article  CAS  PubMed  Google Scholar 

  86. Bahadoer RR, Dijkstra EA, Van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(1):29–42. https://doi.org/10.1016/s1470-2045(20)30555-6.

    Article  CAS  PubMed  Google Scholar 

  87. Wang J, Li S, Liu Y, Zhang C, Li H, Lai B. Metastatic patterns and survival outcomes in patients with stage IV colon cancer: a population-based analysis. Cancer Med. 2020;9(1):361–73. https://doi.org/10.1002/cam4.2673.

    Article  PubMed  Google Scholar 

  88. Vijayvergia N, Li T, Wong Y-N, Hall MJ, Cohen SJ, Dotan E. Chemotherapy use and adoption of new agents is affected by age and comorbidities in patients with metastatic colorectal cancer. Cancer. 2016;122(20):3191–8. https://doi.org/10.1002/cncr.30077.

    Article  PubMed  Google Scholar 

  89. Folprecht G, Cunningham D, Ross P, et al. Efficacy of 5-fluorouracil-based chemotherapy in elderly patients with metastatic colorectal cancer: a pooled analysis of clinical trials. Ann Oncol. 2004;15(9):1330–8. https://doi.org/10.1093/annonc/mdh344.

    Article  CAS  PubMed  Google Scholar 

  90. Goldberg RM, Tabah-Fisch I, Bleiberg H, et al. Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly patients with colorectal cancer. J Clin Oncol. 2006;24(25):4085–91. https://doi.org/10.1200/jco.2006.06.9039.

    Article  CAS  PubMed  Google Scholar 

  91. Feliu J, Salud A, Escudero P, et al. XELOX (capecitabine plus oxaliplatin) as first-line treatment for elderly patients over 70 years of age with advanced colorectal cancer. Br J Cancer. 2006;94(7):969–75. https://doi.org/10.1038/sj.bjc.6603047.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Twelves CJ, Butts CA, Cassidy J, et al. Capecitabine/oxaliplatin, a safe and active first-line regimen for older patients with metastatic colorectal cancer: post hoc analysis of a large phase II study. Clin Colorectal Cancer. 2005;5(2):101–7. https://doi.org/10.3816/ccc.2005.n.021.

    Article  PubMed  Google Scholar 

  93. Figer A, Perez-Staub N, Carola E et al. FOLFOX in patients aged between 76 and 80 years with metastatic colorectal cancer. Cancer 2007;110(12):2666–2671. https://doi.org/10.1002/cncr.23091. Stop-and-go approach in older patients with metastatic colorectal cancer is effective with improved tolerability.

  94. Folprecht G, Seymour MT, Saltz L, et al. Irinotecan/fluorouracil combination in first-line therapy of older and younger patients with metastatic colorectal cancer: combined analysis of 2,691 patients in randomized controlled trials. J Clin Oncol. 2008;26(9):1443–51. https://doi.org/10.1200/jco.2007.14.0509.

    Article  CAS  PubMed  Google Scholar 

  95. Aparicio T, Jouve J-L, Teillet L, et al. Geriatric factors predict chemotherapy feasibility: ancillary results of FFCD 2001–02 phase III study in first-line chemotherapy for metastatic colorectal cancer in elderly patients. J Clin Oncol. 2013;31(11):1464–70. https://doi.org/10.1200/jco.2012.42.9894.

    Article  CAS  PubMed  Google Scholar 

  96. Kopetz S, Grothey A, Yaeger R, et al. Encorafenib, binimetinib, and cetuximab in <i>BRAF</i> V600E–mutated colorectal cancer. N Eng J Med. 2019;381(17):1632–43. https://doi.org/10.1056/nejmoa1908075.

    Article  CAS  Google Scholar 

  97. Van Cutsem E, Rivera F, Berry S, et al. Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol. 2009;20(11):1842–7. https://doi.org/10.1093/annonc/mdp233.

    Article  PubMed  Google Scholar 

  98. Kozloff MF, Sugrue MM, Purdie DM et al. Safety and effectiveness of bevacizumab (BV) and chemotherapy (CT) in elderly patients (pts) with metastatic colorectal cancer (mCRC): Results from the BRiTE observational cohort study. J Clin Oncol 2008;26(15_suppl):4026–4026. https://doi.org/10.1200/jco.2008.26.15_suppl.4026.

  99. Kabbinavar FF, Hurwitz HI, Yi J, Sarkar S, Rosen O. Addition of bevacizumab to fluorouracil-based first-line treatment of metastatic colorectal cancer: pooled analysis of cohorts of older patients from two randomized clinical trials. J Clin Oncol. 2009;27(2):199–205. https://doi.org/10.1200/jco.2008.17.7931.

    Article  CAS  PubMed  Google Scholar 

  100. Cassidy J, Saltz LB, Giantonio BJ, Kabbinavar FF, Hurwitz HI, Rohr U-P. Effect of bevacizumab in older patients with metastatic colorectal cancer: pooled analysis of four randomized studies. J Cancer Res Clin Oncol. 2010;136(5):737–43. https://doi.org/10.1007/s00432-009-0712-3.

    Article  CAS  PubMed  Google Scholar 

  101. Sclafani F, Cunningham D. Bevacizumab in elderly patients with metastatic colorectal cancer. J Geriatr Oncol. 2014;5(1):78–88. https://doi.org/10.1016/j.jgo.2013.08.006.

    Article  PubMed  Google Scholar 

  102. Abdelwahab S, Azmy A, Abdel-Aziz H, Salim H, Mahmoud A. Anti-EGFR (cetuximab) combined with irinotecan for treatment of elderly patients with metastatic colorectal cancer (mCRC). J Cancer Res Clin Oncol. 2012;138(9):1487–92. https://doi.org/10.1007/s00432-012-1229-8.

    Article  CAS  PubMed  Google Scholar 

  103. Mineur L, François E, Phelip JM et al. Cetuximab (CTX) in first-line treatment of elderly patients with metastatic colorectal cancer (mCRC), KRAS wild type: French multicentre prospective community-based registry and results. J Clin Oncol 2017;35(4_suppl):760–760. https://doi.org/10.1200/JCO.2017.35.4_suppl.760.

  104. Jehn CF, Böning L, Kröning H, Possinger K, Lüftner D. Cetuximab-based therapy in elderly comorbid patients with metastatic colorectal cancer. Br J Cancer. 2012;106(2):274–8. https://doi.org/10.1038/bjc.2011.554.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  105. Sastre J, Aranda E, Gravalos C et al. First-line single-agent cetuximab in elderly patients with metastatic colorectal cancer. A phase II clinical and molecular study of the Spanish group for digestive tumor therapy (TTD). Crit Rev Oncol Hematol 2011;77(1):78–84. https://doi.org/10.1016/j.critrevonc.2009.11.005.

  106. Dotan E, Devarajan K, D’Silva AJ, et al. Patterns of use and tolerance of anti-epidermal growth factor receptor antibodies in older adults with metastatic colorectal cancer. Clin Colorec Cancer. 2014;13(3):192–8. https://doi.org/10.1016/j.clcc.2014.05.003.

    Article  Google Scholar 

  107. Raimondi A, Fucà G, Leone AG et al. Impact of age and gender on the efficacy and safety of upfront therapy with panitumumab plus FOLFOX followed by panitumumab-based maintenance: a pre-specified subgroup analysis of the Valentino study. ESMO Open 2021;6(5):100246. https://doi.org/10.1016/j.esmoop.2021.100246.

  108. Papamichael D, Lopes GS, Olswold CL, et al. Efficacy of anti-epidermal growth factor receptor agents in patients with RAS wild-type metastatic colorectal cancer >/= 70 years. Eur J Cancer. 2022;163:1–15. https://doi.org/10.1016/j.ejca.2021.12.007.

    Article  CAS  PubMed  Google Scholar 

  109. Battaglin F, Schirripa M, Buggin F et al. The PANDA study: a randomized phase II study of first-line FOLFOX plus panitumumab versus 5FU plus panitumumab in RAS and BRAF wild-type elderly metastatic colorectal cancer patients. BMC Cancer 2018;18(1). https://doi.org/10.1186/s12885-018-4001-x.

  110. Clarke CN, Kopetz ES. BRAF mutant colorectal cancer as a distinct subset of colorectal cancer: clinical characteristics, clinical behavior, and response to targeted therapies. J Gastrointest Oncol 2015;6(6):660–667. https://jgo.amegroups.com/article/view/4881. Accessed 9/10/2022.

  111. Tabernero J, Grothey A, Van Cutsem E, et al. Encorafenib plus cetuximab as a new standard of care for previously treated <i>BRAF</i> V600E–mutant metastatic colorectal cancer: updated survival results and subgroup analyses from the BEACON study. J Clin Oncol. 2021;39(4):273–84. https://doi.org/10.1200/jco.20.02088.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  112. Ng K, Ciardiello F, Van Cutsem E, et al. SO-37 Evaluating age as a factor for survival and quality of life in patients with BRAF V600E-mutant metastatic colorectal cancer treated with encorafenib + cetuximab ± binimetinib: Subanalysis of BEACON CRC. Ann Oncol. 2022;33:S372–3. https://doi.org/10.1016/j.annonc.2022.04.435.

    Article  Google Scholar 

  113. Seymour C. Encorafenib/Cetuximab ± Binimetinib Improves Survival Regardless of Age in BRAF V600E–Mutant mCRC. August 30, 2022. https://www.onclive.com/view/encorafenib-cetuximab-binimetinib-improves-survival-regardless-of-age-in-braf-v600e-mutant-mcrc. Accessed 9/10/2022.

  114. Van Cutsem E, Mayer RJ, Laurent S, et al. The subgroups of the phase III RECOURSE trial of trifluridine/tipiracil (TAS-102) versus placebo with best supportive care in patients with metastatic colorectal cancer. Eur J Cancer. 2018;90:63–72. https://doi.org/10.1016/j.ejca.2017.10.009.

    Article  CAS  PubMed  Google Scholar 

  115. Cutsem Ev, Sobrero A, Siena S et al. Regorafenib (REG) in progressive metastatic colorectal cancer (mCRC): Analysis of age subgroups in the phase III CORRECT trial. J Clin Oncol 2013;31(15_suppl):3636–3636. https://doi.org/10.1200/jco.2013.31.15_suppl.3636.

  116. Cutsem EV, Ciardiello F, Ychou M et al. Regorafenib in previously treated metastatic colorectal cancer (mCRC): Analysis of age subgroups in the open-label phase IIIb CONSIGN trial. J Clin Oncol 2016;34(15_suppl):3524–3524. https://doi.org/10.1200/JCO.2016.34.15_suppl.3524.

  117. Grothey A, Van Cutsem E, Sobrero A, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 2013;381(9863):303–12. https://doi.org/10.1016/S0140-6736(12)61900-X.

    Article  CAS  PubMed  Google Scholar 

  118. Bekaii-Saab TS, Ou FS, Ahn DH, et al. Regorafenib dose-optimisation in patients with refractory metastatic colorectal cancer (ReDOS): a randomised, multicentre, open-label, phase 2 study. Lancet Oncol. 2019;20(8):1070–82. https://doi.org/10.1016/S1470-2045(19)30272-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  119. Overman MJ, Lonardi S, Wong KYM, et al. Durable clinical benefit with nivolumab plus ipilimumab in DNA mismatch repair–deficient/microsatellite instability-high metastatic colorectal cancer. J Clin Oncol. 2018;36(8):773–9. https://doi.org/10.1200/jco.2017.76.9901.

    Article  CAS  PubMed  Google Scholar 

  120. André T, Shiu K-K, Kim TW, et al. Pembrolizumab in microsatellite-instability–high advanced colorectal cancer. N Eng J Med. 2020;383(23):2207–18. https://doi.org/10.1056/nejmoa2017699.

    Article  CAS  Google Scholar 

  121. Aparicio T, Schischmanoff O, Poupardin C, et al. Deficient mismatch repair phenotype is a prognostic factor for colorectal cancer in elderly patients. Dig Liver Dis. 2013;45(3):245–50. https://doi.org/10.1016/j.dld.2012.09.013.

    Article  CAS  PubMed  Google Scholar 

  122. Kakar S, Burgart LJ, Thibodeau SN, et al. Frequency of loss ofhMLH1 expression in colorectal carcinoma increases with advancing age. Cancer. 2003;97(6):1421–7. https://doi.org/10.1002/cncr.11206.

    Article  CAS  PubMed  Google Scholar 

  123. Gomes F, Wong M, Battisti NML, et al. Immunotherapy in older patients with non-small cell lung cancer: Young International Society of Geriatric Oncology position paper. Br J Cancer. 2020;123(6):874–84. https://doi.org/10.1038/s41416-020-0986-4.

    Article  PubMed  PubMed Central  Google Scholar 

  124. Nishiyama N, Kobayashi T, Narita S, et al. Efficacy and safety of pembrolizumab for older patients with chemoresistant urothelial carcinoma assessed using propensity score matching. J Geriatr Oncol. 2022;13(1):88–93. https://doi.org/10.1016/j.jgo.2021.07.002.

    Article  CAS  PubMed  Google Scholar 

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    Dina Ioffe MD & Efrat Dotan MD

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Dina Ioffe declares no conflict of interest. Efrat Dotan has received research support provided to the institution from Relay, AstraZeneca, Medimmune, Zymeworks, Incyte, Gilead, Lutris, and NGM Biopharmaceuticals; and has received honoraria for lectures and advisory boards from Pfizer, Helsinn, Incyte, Taiho, G1 therapeutics, Basilea, QED, and Pfizer.

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Ioffe, D., Dotan, E. Guidance for Treating the Older Adults with Colorectal Cancer. Curr. Treat. Options in Oncol. 24, 644–666 (2023). https://doi.org/10.1007/s11864-023-01071-6

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