Targeted agents: review of toxicity in the elderly metastatic colorectal cancer patients

Abstract

Colorectal cancer remains a major cause of cancer mortality in the Western world. With a median age at presentation of 71, patients with metastatic disease are often elderly with significant co-morbidities. In addition, elderly patients are more likely to be undertreated and under-represented in clinical trials. Therefore, as the available data from clinical trials are scarce, the optimal treatment strategy for this group of patients has not been adequately defined. In the setting of metastatic colorectal cancer, the introduction of so called targeted agents has significantly improved outcomes in the context of randomized clinical trials, while at the same time increasing treatment options for such patients. This review focuses on the role of targeted therapies in elderly patients with metastatic colorectal cancer, with specific reference to toxicity and tolerability. It should be noted that studies reviewed herein will have mostly included fit elderly patients fulfilling specific inclusion criteria. The available data so far are limited but suggest that targeted agents have similar efficacy and tolerability in elderly fit patients when compared with younger ones, provided caution is exercised in specific high-risk sub-groups. Clearly, further studies aimed at this specific patient population using well-established geriatric end-points will hopefully identify those patients more likely to benefit and less likely to suffer severe side effects.

Efficacy and safety of bevacizumab in elderly patients with metastatic colorectal cancer: results from the Czech population-based registry

“…Moreover, the incidence of hypertension was also found to be age-related [22]. Bleeding, gastrointestinal perforations, and wound healing complications were observed less often [23]. In the present study, the above mentioned adverse events were recorded less frequently than in previously reported (Table 4).…”

A Geriatric Assessment Intervention to Reduce Treatment Toxicity Among Older Adults With Advanced Lung Cancer: A Subgroup Analysis From a Cluster Randomized Controlled Trial

“…Furthermore, older patients who are treated with chemotherapy are at high risk for adverse outcomes, including chemotherapy toxicity and functional and physical consequences ( 19 – 21 ). In addition, older adults are more susceptible to toxicity from combination chemotherapy plus newer immunotherapy or targeted kinase inhibitors ( 22 – 25 ). In a randomized controlled trial by Corre et al, GA-guided lung cancer treatment strategies have been shown to lower symptomatic toxicities and improve other clinical outcomes among older adults receiving chemotherapy for advanced lung cancer ( 26 ).…”

Commentary on Young et al.

“…The management of colorectal cancer has evolved into a truly multidisciplinary model. Several studies suggest that the types of treatment modalities used, the order in which they are applied as well as the particular combinations of therapies influence outcomes depending upon tumour factors including the anatomical segment involved and the location and extent of disease, whether previous treatments were used and patient‐related factors. Deviations from treatment guidelines have an adverse influence on the outcome for colorectal cancer .…”