Bevacizumab in elderly patients with metastatic colorectal cancer

The progressively ageing population combined with an increased availability of antitumoural agents has created a new, challenging therapeutic scenario for oncologists. Due to the lack of evidence-based data on elderly patients it is uncertain whether the criteria for assessing the risk/benefit ratio of treatment strategies in these patients coincide with those classically used for the general population. A critical reevaluation of the role and potential options of systemic chemotherapy in elderly patients with metastatic colorectal cancer (mCRC) is warranted as the historical conservative approach of oncologists may have resulted in undertreatment of this patient population. Bevacizumab was demonstrated to improve the outcome of mCRC patients when used in combination with standard first and second line chemotherapy. However, its toxicity profile including hypertension, thromboembolic events, haemorrhage and proteinuria may raise important concerns when this anti-angiogenic agent is used in elderly patients with comorbidities. In this review article we analyse the available evidence on the safety and effectiveness of bevacizumab in elderly mCRC patients. Based on the data from subgroup or pooled analysis of prospective trials, observational cohort studies, retrospective population-based studies and a single recent randomised phase III trial, we conclude that the clinical benefit and safety profile of bevacizumab in elderly patients are not significantly different from those reported in younger patients, with the exception of an increased risk of arterial thromboembolic events. Bevacizumab should therefore be considered as a potential therapeutic option for elderly patients with mCRC.