Chemotherapy Strategies for Elderly Patients with Metastatic Colorectal Cancer
Summary
The management of metastatic colorectal cancer in elderly patients demands a careful balance between efficacy and tolerability. Age-related organ decline, comorbidities and frailty increase the risk of treatment-related toxicity, yet effective systemic therapy remains central to prolonging survival and preserving quality of life. Standard fluoropyrimidine-based regimens often serve as the backbone of therapy, with oxaliplatin or irinotecan added according to patient fitness. Dose modifications and monotherapy strategies have been developed to reduce adverse events while maintaining benefit. The integration of targeted agents, notably anti-angiogenic drugs such as bevacizumab, can enhance progression-free intervals, though their safety profile requires vigilant monitoring in the elderly. Biomarker-driven approaches—for example identifying microsatellite instability to guide immunotherapy—are emerging as critical tools for stratifying older patients most likely to benefit. Comprehensive geriatric assessment enables individualised treatment plans that factor in functional status, nutritional reserve and cognitive function, ensuring that systemic therapy is both safe and effective in this heterogeneous population.
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Chemotherapy Strategies for Elderly Patients with Metastatic Colorectal Cancer publication trend
The graph below shows the total number of articles in chemotherapy strategies for elderly patients with metastatic colorectal cancer across all publications each year (not limited to Nature Index journals).
Technical terms
Comprehensive Geriatric Assessment: A multidimensional evaluation of an older patient’s health status, including functional, cognitive, nutritional and social domains, used to guide treatment decisions.
Fluoropyrimidine: A class of antimetabolite chemotherapy agents (e.g. 5-fluorouracil, capecitabine) that inhibit DNA synthesis in rapidly dividing cells.
Oxaliplatin: A platinum-based chemotherapeutic often combined with fluoropyrimidines, active against colorectal cancer.
Irinotecan: A topoisomerase I inhibitor employed in combination regimens to treat metastatic colorectal cancer.
Progression-Free Survival (PFS): The duration during and after treatment in which a patient’s disease does not worsen.
Overall Survival (OS): The time from treatment initiation until death from any cause.
Microsatellite Instability (MSI): A molecular marker indicating defects in DNA mismatch repair, predictive of response to immune checkpoint inhibitors.
References
- Chemotoxicity and Associated Risk Factors in Colorectal Cancer: A Systematic Review and Meta-Analysis. Cancers (2024).
- Quality of Life in Vulnerable Older Patients with Metastatic Colorectal Cancer Receiving Palliative Chemotherapy—The Randomized NORDIC9-Study. Cancers (2021).
- Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer. Journal of Clinical Medicine (2020).
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