Editorial
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World J Gastroenterol. Apr 14, 2013; 19(14): 2131-2140
Published online Apr 14, 2013. doi: 10.3748/wjg.v19.i14.2131
Angiogenic inhibitors for older patients with advanced colorectal cancer: Does the age hold the stage?
Giuseppe Aprile, Caterina Fontanella, Eufemia Stefania Lutrino, Laura Ferrari, Mariaelena Casagrande, Giovanni Gerardo Cardellino, Gerardo Rosati, Gianpiero Fasola
Giuseppe Aprile, Caterina Fontanella, Eufemia Stefania Lutrino, Laura Ferrari, Mariaelena Casagrande, Giovanni Gerardo Cardellino, Gianpiero Fasola, Department of Oncology, University and General Hospital, 33100 Udine, Italy
Gerardo Rosati, Medical Oncology Unit, San Carlo Hospital, 85100 Potenza, Italy
Author contributions: All authors contributed equally to the intellectual conception of the manuscript and approved the final version of the present manuscript; Fontanella C, Lutrino ES, Ferrari L, Casagrande M, and Cardellino GG performed extensive literature search and drafted the article; Aprile G, Rosati G and Fasola G revised the manuscript critically.
Correspondence to: Giuseppe Aprile, MD, Department of Oncology, University and General Hospital, Piazzale S Maria della Misericordia 1, 33100 Udine, Italy. aprile.giuseppe@aoud.sanita.fvg.it
Telephone: +39-432-559308 Fax:+39-432-559305
Received: March 9, 2013
Revised: April 12, 2013
Accepted: April 13, 2013
Published online: April 14, 2013
Abstract

Although major progress has been achieved in the treatment of advanced colorectal cancer (CRC) with the employment of antiangiogenic agents, several questions remain on the use of these drugs in older patients. Since cardiovascular, renal and other comorbidities are common in the elderly, an accurate assessment of the patients’ conditions should be performed before a treatment decision is made. Since most CRC patients enrolled in clinical trials testing antiangiogenic drugs were aged < 65 years, the efficacy and tolerability of these agents in elderly patients has not been adequately explored. Data suggest that patients with advanced CRC derive similar benefit from bevacizumab treatment regardless of age, but the advantage of other antiangiogenic drugs in the same class of patients appears more blurred. Literature data suggest that specific antiangiogenic-related toxicities such as hypertension or arterial thromboembolic events may be higher in the elderly than in the younger patients. In addition, it should be emphasized that the patients included in the clinical studies discussed herein were selected and therefore may not be representative of the usual elderly population. Advanced age alone should not discourage the use of bevacizumab. However, a careful patients’ selection and watchful monitoring of toxicities are required to optimize the use of antiangiogenics in this population.

Keywords: Advanced colorectal cancer, Bevacizumab, Elderly, Antiangiogenesis, Chemotherapy

Core tip: Although promising, limited evidence supports the use of antiangiogenic drugs to treat elderly colorectal cancer patients, that also may have increased toxicities compared to younger subjects. However, advanced age per-se should not discourage the use of these drugs. Since older patients constitute a heterogeneous population in terms of overall health status and comorbid conditions, a careful patients’ selection and a watchful monitoring of potential treatment-related side effects are recommended to optimize the use of angiogenesis inhibitors in this population.