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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2015; 21(17): 5158-5166
Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5158
Chemotherapy for colorectal cancer in the elderly
Jung Han Kim
Jung Han Kim, Division of Hemato-Oncology, Department of Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul 150-950, South Korea
Author contributions: Kim JH reviewed the available data in the literature and wrote the manuscript.
Conflict-of-interest: The author has no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jung Han Kim, MD, PhD, Division of Hemato-Oncology, Department of Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Shingil-ro 1, Youngdungpo-Gu, Seoul 150-950, South Korea. harricil@hotmail.com
Telephone: +82-2-8345414 Fax: +82-2-8464669
Received: November 26, 2014
Peer-review started: November 26, 2014
First decision: February 10, 2015
Revised: March 2, 2015
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: May 7, 2015
Processing time: 168 Days and 4.5 Hours
Abstract

Colorectal cancer (CRC) is one of the leading causes of cancer-related death in the elderly. However, elderly patients with CRC tend to be under-presented in clinical trials and undertreated in clinical practice. Advanced age alone should not be the only criteria to preclude effective therapy in elderly patients with CRC. The best guide about optimal cancer treatment can be provided by comprehensive geriatric assessment. Elderly patients with stage III colon cancer can enjoy the same benefit from adjuvant chemotherapy with 5-fluorouracil/leucovorin or capecitabine as younger patients, without a substantial increase in toxicity. With conflicting results of retrospective studies and a lack of data available from randomized studies, combined modality treatment should be used with great caution in elderly patients with locally advanced rectal cancer. Combination chemotherapy can be considered for older patients with metastatic CRC. For elderly patients who are frail or vulnerable, however, monotherapy or a stop-and-go strategy may be desirable. The use of targeted therapies in older patients with metastatic CRC appears to be promising in view of their better efficacy and toxicity. Treatment should be individualized based on the nature of the disease, the physiologic or functional status, and the patient’s preference.

Keywords: Adjuvant chemotherapy; Colorectal cancer; Elderly; Palliative chemotherapy; Review

Core tip: Colorectal cancer (CRC) is one of the leading causes of cancer-related death in the elderly. However, elderly patients with CRC tend to be under-presented in clinical trials and undertreated in clinical practice. In older patients with CRC, advanced age alone should not be the only criteria to preclude adjuvant or palliative chemotherapy that is effective in younger patients. This review provides readers with a better understanding of the potential benefit of chemotherapy in older patients with CRC.