Chemotherapy for the elderly patient with colorectal cancer

Colorectal cancer is a common cancer in older patients with nearly 70% of all cases diagnosed in patients 65 years and older. Many chemotherapy clinical trials that have advanced the field in both localized and metastatic disease have not included patients from the age group most representative of the disease. Retrospective series and subset analyses show that older patients derive the same benefit from optimum multimodality strategies as their younger counterparts. Lack of prospective data and a generalization of increased toxicity rates seen in older patients with multiple comorbidities to the overall heterogenous population of older patients have lead to a reluctance to treat older patients with modern chemobiologic therapy. Despite increased comorbidities, decreased hepatic reserve, and an under-representation of older patients undergoing liver resection, the majority of published data does not support a negative correlation between poor outcome and increasing age. There is an urgent need to include older patients in clinical trials for colorectal cancer and to understand and use geriatric assessment scoring systems to identify those patients most likely to benefit from optimum treatment.