How should we treat older patients with Metastatic Colorectal Cancer; A Review

Nearly 50 % of newly diagnosed colorectal cancer, affect people over 70 years of age. Inclusion of older patients in clinical trials has been extremely rare. As a result, there is debate on how to manage these patients because it is still unclear how to balance the therapeutic advantages and toxicities. For patients who do not have comorbid conditions, with performance status (P.S.) 0–1, treatment guidelines are comparable to those for younger ones. Chemotherapy is an option for older patients; however, a full geriatric evaluation is recommended. Bevacizumab, an anti-vascular epithelial growth factor (anti-VEGF), combined with chemotherapy has become a standard of care in older patients. Anti-epidermal growth factor receptor (anti-EGFR) treatment is proposed both as monotherapy in the third-line or with chemotherapy in first or second line. Clinical trials that compared chemotherapy alone versus doublet chemotherapy plus anti-EGFR in older patients found that age is not an absolute contraindication for using anti- EGFR in first or second line. In fit older patients, anti-EGFR monotherapy in the first second or third line has demonstrated feasibility and antitumor efficacy. The major side effect is cutaneous rash which is easily managed. However, treatment in older patients should be carried out and be based on co-morbidities.