Abstract
Despite the high prevalence of colorectal cancer in a continuously aging population and the substantial advances in the treatment of metastatic disease during the past decade, the treatment of elderly patients with advanced, unresectable or metastatic colorectal cancer is a clearly unmet need. Since older patients are under-represented or even excluded from randomized trials, the evidence that oncologists use as guidance is weak. However, small prospective studies, pooled analyses and observational studies show that combination approaches are safe, efficacious and feasible in the geriatric population with metastatic colorectal cancer. The use of biologic agents targeting angiogenesis and the epidermal growth factor receptor, which have been shown to clearly improve outcomes in multiple prospective trials in patients with advanced colorectal cancer, is a vital component of the aforementioned combination approaches. Herein, we review all available data concerning the management of elderly patients with these agents and underscore the differences between this age subgroup and younger patients.
Highlights
Colorectal cancer (CRC) is a disease of the elderly
Evidence that could guide the treatment of elderly patients mCRC are sparse; this patient group is often under-represented in prospective trials or their representation is skewed, as patients of poorer functional status are excluded and only recently have trials of elderly patients only been published in the literature
Another novel targeted treatment for patients with mCRC is the use of oncolytic viruses, such as Reolysin, which targets cancer cells with an activated RAS pathway and is being tested in a phase 2 trial combined with standard treatment (FOLFOX and bevacizumab, NCT01622543)
Summary
Colorectal cancer (CRC) is a disease of the elderly. Approximately 60% of cases are diagnosed in patients over 65 years old, with a median age of 69 at diagnosis [1]. The significant progress in the management of mCRC with the introduction of multiple effective cytotoxics, such as oxaliplatin and irinotecan, and targeted agents, such as bevacizumab, cetuximab, panitumumab, aflibercept and regorafenib, has greatly improved outcomes; the reported overall survival (OS) in recent trials often exceeds 30 months. Whether these advances can be applied to geriatric patients is a matter of debate. We review the available published data concerning the use of agents that target angiogenesis and the epidermal growth factor receptor (EGFR) in elderly patients with mCRC
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