Chemotherapy for Colorectal Cancer in the Elderly

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Introduction

Colorectal cancer is the second leading cause of cancer-related mortality in the United States, with an estimated 52,180 deaths attributable to this disease in 2007 alone. The majority of these patients are elderly, as the median age of patients at the time of diagnosis is about 65 to 70 years old.¹ Overall, the outcomes of therapy for patients with colorectal cancer have advanced dramatically over the past decade with the development and approval of six new agents with widely distinctive mechanisms of action. However, the evidence that such therapies are beneficial to the largest segment of the population that is afflicted with this disease is lacking.

The reasons for the lack of data can be traced to several sources. To begin, as people age, they change physiologically (eg, decreased renal function) and often acquire comorbidities that may lead to a decline in functional status; this process certainly raises concerns about a patient’s ability to tolerate combination chemotherapy. In addition, and perhaps because of those reasons, many studies have excluded patients older than 70 or 75 years of age. This fact also reflects the question of what constitutes the “elderly” population:  the traditionally used, but probably outmoded, definition of patients older than 65 or perhaps 70 or even 75 or 85 years old. The patients on the trials are generally the “fit” elderly and may not reflect many of the patients in the community. Also, participation by patients older than age 80 is rare; therefore, extrapolation of data to this group must be done with caution. 

Clinical opinions expressed in this program are those of the authors and do not necessarily reflect the opinions of the supporters, publishers, editors, or officers of CMPMedica or Beam Institute.