Current Treatment Options in Oncology

, Volume 10, Issue 5–6, pp 287–295 | Cite as

Treatment of Metastatic Colorectal Cancer in the Elderly

Geriatric Oncology

Opinion statement

Metastatic colorectal cancer (CRC) is the second leading cause of cancer related mortality in the United States. The median age of patients at diagnosis is over 70, so as the American population ages, it can be expected that the incidence of CRC will also increase. There is limited prospective data regarding the safety and efficacy of chemotherapy in elderly patients with metastatic CRC. However, the data that are available suggest that elderly patients with a good performance status have a similar likelihood of response to currently available chemotherapy, though perhaps a somewhat higher likelihood of toxicities such as myelosuppression. This paper reviews the available data and recommendations for the treatment of this patient population.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

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

  1. 1.
    SEER Cancer Statistics Review, 1975–2006, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2006/, based on November 2008 SEER data submission, posted to the SEER web site, 2009
  2. 2.
    Jemal, A.: CA: A Cancer Journal for Clinicians, May 27, 2009; advance online edition. News release, American Cancer Society. American Cancer Society: Cancer Prevention & Early Detection Facts & Figures, 2009Google Scholar
  3. 3.
    Lichtman, S, et al.: Colorectal Cancer in the Elderly Patient: Assessment and Treatment. New York, NY: Oncology Publishing Group, 2005Google Scholar
  4. 4.
    McKibbin T, et al.: Disparities in the use of chemotherapy and monoclonal antibody therapy for elderly advanced colorectal cancer patients in the community oncology setting. Oncologist 2008, 13(8):876–885.CrossRefPubMedGoogle Scholar
  5. 5.
    Goodwin J, et al.: Determinants of cancer therapy in elderly patients. Cancer 2006, 72(2):594–601.CrossRefGoogle Scholar
  6. 6.
    Aapro MS: Never too old? Age should not be a barrier to enrollment in cancer clinical trials. Oncologist 2005, 10(3):198–204.CrossRefPubMedGoogle Scholar
  7. 7.••
    Papamichael D: Treatment of the elderly colorectal cancer patient: SIOG expert recommendations. Ann Oncol 2009, 20(1):5–16.CrossRefPubMedGoogle Scholar
  8. 8.
    Baker SD: Role of body surface area in dosing of investigational anticancer agents in adults, 1991–2001. J Natl Cancer Inst 2002, 94(24):1883–1888.PubMedGoogle Scholar
  9. 9.
    Honecker F, Kohne CH, Bokemeyer C: Colorectal cancer in the elderly: is palliative chemotherapy of value. Drugs Aging 2003, 20:1–11.CrossRefPubMedGoogle Scholar
  10. 10.••
    Au HJ, Mulder KE, Fields AL: Systemic review of management of colorectal cancer in elderly patients. Clin Colorectal Cancer 2003, 3(3):165–171.CrossRefPubMedGoogle Scholar
  11. 11.
    Sargent DJ, et al.: A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 2001, 345(15):1091–1097.CrossRefPubMedGoogle Scholar
  12. 12.
    Feliu J: XELOX (capecitabine plus oxaliplatin) as first-line treatment for elderly patients over 70 years of age with advanced colorectal cancer. Br J Cancer 2006, 94:969–975.CrossRefPubMedGoogle Scholar
  13. 13.
    Mattioli R, et al.: High activity and reduced neurotoxicity of bi-fractionated oxaliplatin plus 5-fluorouracil/leucovorin for elderly patients with advanced colorectal cancer. Ann Oncol 2005, 16:1147–1151.CrossRefPubMedGoogle Scholar
  14. 14.
    Figer A, et al.: FOLFOX in Pts aged between 76 and 80 yrs with metastatic colorectal cancer, an exploratory cohort of the OPTIMOX1 Study. Cancer 2007, 110:2666–2671.CrossRefPubMedGoogle Scholar
  15. 15.•
    Goldberg RM, et al.: A pooled analysis to assess safety and efficacy of FOLFOX4 regimen (bimonthly oxaliplatin plus 5FfU/leukovorin) in elderly pts with colorectal cancer. J Clin Oncol 2006, 24:4085–4091.CrossRefPubMedGoogle Scholar
  16. 16.
    Comella P, et al.: Cepecitabine plus oxaliplatin for the first-line treatment of elderly pts with metstatic CRC. Cancer 2005, 104:282–289.CrossRefPubMedGoogle Scholar
  17. 17.
    Chau I, et al.: Elderly patients with fluoropyrimidine and thymidylate synthase inhibitor-resistant advanced colorectal cancer derive similar benefit without excessive toxicity when treated with irinotecan monotherapy. Br J Cancer 2004, 91:1453–1458.CrossRefPubMedGoogle Scholar
  18. 18.
    Fuchs CS, et al.: Phase III comparison of two irinotecan dosing regimens in second-line therapy of metastatic colorectal cancer. J Clin Oncol 2003, 21:807–814.CrossRefPubMedGoogle Scholar
  19. 19.
    Sargent DJ, et al.: Recommendation for caution with irinotecan, fluorouracil, and leucovorin for colorectal cancer. N Engl J Med 2001, 345(2):144–145.CrossRefPubMedGoogle Scholar
  20. 20.
    Souglakos J, et al.: Combination of irinotecan (CPT-11) plus 5-fluorouracil and leucovorin (FOLFIRI Regimen) as first line treatment for elderly patients with metastatic colorectal cancer: a phase II trial. Oncology 2005, 69:384–390.CrossRefPubMedGoogle Scholar
  21. 21.
    Sastre J, et al.: Irinotecan in combination with 5FU in a 48 hr continuous infusion as 1st line for elderly with metastatic colorectal cancer. J Clin Oncol 2005, 23:3534–3551.CrossRefGoogle Scholar
  22. 22.•
    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):1443–1451.CrossRefPubMedGoogle Scholar
  23. 23.
    Hurwitz H, Fehrenbacher L, Novotny W, et al.: Bevacizumab plus irinotean, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004, 350(23):2335–2342Google Scholar
  24. 24.
    Patt YZ, et al.: Capecitabine plus 3-weekly irinotecan (XELIRI Regimen) as first-line chemotherapy for metastatic colorectal cancer: Phase II trial results. Am J Clin Oncol 2007, 30(4):350–357.CrossRefPubMedGoogle Scholar
  25. 25.
    Giantonio BJ, et al.: Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 2007, 25(12):1539–1544.CrossRefPubMedGoogle Scholar
  26. 26.•
    Scappaticci FA, et al.: Arterial thromboembolic events in patients with metastatic carcinoma treated with chemotherapy and bevacizumab. J Natl Cancer Inst 2007, 99(16):1232–1239.CrossRefPubMedGoogle Scholar
  27. 27.
    Raman AK, et al.: Bevacizumab related adverse events among various age groups of elderly patients with advanced colorectal cancer. J Clin Oncol 2007, 25(18S):14546.Google Scholar
  28. 28.
    Tabernero J, et al.: Phase II trial of cetuximab in combination with fluorouracil, leucovorin, and oxaliplatin in the first-line treatment of metastatic colorectal cancer. J Clin Oncol 2007, 25(33):5225–5232.CrossRefPubMedGoogle Scholar
  29. 29.
    Lichtman, S., et al.: Chemotherapy Toxicity: Focus on the Older Cancer Patient. New York, NY: Oncology Publishing Group, 2008Google Scholar
  30. 30.
    Pasetto LM, et al.: How many colorectal cancer (CRC) patients older than 70 years may be safely treated with bevacizumab? J Clin Oncol 2006, 24:13589.Google Scholar
  31. 31.
    Saltz LB, et al.: Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008, 26(12):2013–2019.CrossRefPubMedGoogle Scholar
  32. 32.
    Kabbinavar FF, et al.: Addition of bevacizumab to bolus fluorouracil and leucovorin in first-line metastatic colorectal cancer: results of a randomized phase II trial. J Clin Oncol 2005, 23(16):3697–3705.CrossRefPubMedGoogle Scholar
  33. 33.
    Cunningham D, et al.: Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004, 351(4):337–345.CrossRefPubMedGoogle Scholar
  34. 34.
    Thomas M: Cetuximab: adverse event profile and recommendations for toxicity management. Clin J Oncol Nursing 2005, 9(3):1092–1095.Google Scholar
  35. 35.•
    Bouchahda MT, et al.: Cetuximab efficacy and safety in a retrospective cohort of elderly patients with heavily pretreated metastatic colorectal cancer. Crit Rev Oncol/Hematol 2008, 67(3):255–262.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Division of Hematology/OncologyLombardi Comprehensive Cancer CenterWashingtonUSA

Personalised recommendations