Management of locally advanced and metastatic colon cancer in elderly patients

Abstract

Colon cancer is the second leading cause of cancer mortality in the United States with a median age at diagnosis of 69 years. Sixty percent are diagnosed over the age of 65 years and 36% are 75 years or older. At diagnosis, approximately 58% of patients will have locally advanced and metastatic disease, for which systemic chemotherapy has been shown to improve survival. Treatment of cancer in elderly patients is more challenging due to multiple factors, including disabling co-morbidities as well as a decline in organ function. Cancer treatment of elderly patients is often associated with more toxicities that may lead to frequent hospitalizations. In locally advanced disease, fewer older patients receive adjuvant chemotherapy despite survival benefit and similar toxicity when compared to their younger counterparts. A survival benefit is also observed in the palliative chemotherapy setting for elderly patients with metastatic disease. When treating elderly patients with colon cancer, one has to consider drug pharmacokinetics and pharmacodynamics. Since chronological age is a poor marker of a patient’s functional status, several methods of functional assessment including performance status and activities of daily living (ADL) or instrumental ADL, or even a comprehensive geriatric assessment, may be used. There is no ideal chemotherapy regimen that fits all elderly patients and so a regimen needs to be tailored for each individual. Important considerations when treating elderly patients include convenience and tolerability. This review will discuss approaches to the management of elderly patients with locally advanced and metastatic colon cancer.

Keywords: Colon cancer, Elderly, Chemotherapy, Management, Toxicity

Core tip: Despite survival benefit, fewer older patients with colon cancer receive chemotherapy, likely due to concerns regarding safety and efficacy of chemotherapy. The decision to treat elderly patients with advanced and metastatic colon cancer requires the incorporation of a thorough evaluation. Fit elderly patients are especially appropriate for treatment and should be offered the same regimens as their younger counterparts. Treatment related toxicities and quality of life should be monitored very closely in elderly patients receiving chemotherapy and more frequent follow-up should be arranged. In frail elderly patients, sequential single agent chemotherapy may be more tolerable than combination therapy.