Chemotherapy of advanced colorectal carcinoma: Treatment decisions for elderly patients

At present, approximately 70% of patients with colorectal cancer are older than 65 years at the time of diagnosis. This cancer population needs to be thoroughly assessed for the benefits of adjuvant or palliative chemotherapy. A comprehensive geriatric assessment may allow subdividing the population of elderly cancer patients into three groups thus helping to guide treatment decisions. It has been demonstrated that the use of 5-fluorouracil (5-FU) based adjuvant chemotherapy in elderly patients effectively reduces mortality and can be applied with acceptable toxicity. Systemic chemotherapy for patients with metastatic disease will have palliative effects and lead to prolongation of survival. While several data exist for the combination of 5-FU and folinic acid in elderly patients, data about combination chemotherapy with 5-FU and new drugs such as irinotecan or oxaliplatin is still limited. There appears to be an age-associated increase in drug-specific toxicity when these agents are used. However, for carefully selected elderly patients receiving adequate monitoring throughout therapy these new treatment approaches can be made available. Clinical studies also indicate that treatment effectiveness in selected elderly patients is comparable to that observed in the younger patient population. Future trials need to further redefine treatment strategies in elderly patients with colorectal cancer.