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Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer

Colorectal cancer (CRC) is one of the main causes of cancer death in the elderly. The older patients constitute a heterogeneous group in terms of functional status, comorbidities, and aging-related conditions. Therefore, therapeutic decisions need to be individualized. Additionally, a higher toxicit...

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Autores principales: Tuca, Albert, Gallego, Rosa, Ghanem, Ismael, Gil-Raga, Mireia, Feliu, Jaime
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764481/
https://www.ncbi.nlm.nih.gov/pubmed/33322567
http://dx.doi.org/10.3390/jcm9124015
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author Tuca, Albert
Gallego, Rosa
Ghanem, Ismael
Gil-Raga, Mireia
Feliu, Jaime
author_facet Tuca, Albert
Gallego, Rosa
Ghanem, Ismael
Gil-Raga, Mireia
Feliu, Jaime
author_sort Tuca, Albert
collection PubMed
description Colorectal cancer (CRC) is one of the main causes of cancer death in the elderly. The older patients constitute a heterogeneous group in terms of functional status, comorbidities, and aging-related conditions. Therefore, therapeutic decisions need to be individualized. Additionally, a higher toxicity risk comes from the fact that pharmacokinetics and pharmacodynamics of the drugs as well as the tissue tolerance can be altered with aging. Although the chemotherapy efficacy in metastatic colorectal cancer (mCRC) is similar for older and young patients, more toxicity is presented in the elderly. While the mono-chemotherapy provides the same benefit for young and older patients, doublets front-line chemotherapy improves progression-free survival (PFS) but not overall survival (OS) in the elderly. Furthermore, the benefit of the addition of bevacizumab to chemotherapy in older patients has been shown in several clinical trials, while the clinical data for the benefit of anti-epidermal growth factor antibodies are scarcer. Immunocheckpoint inhibitors could be an appropriate option for patients with microsatellite instability (MSI) tumors. A prior geriatric assessment is required before deciding the type of treatment in order to offer the best therapeutic option.
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spelling pubmed-77644812020-12-27 Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer Tuca, Albert Gallego, Rosa Ghanem, Ismael Gil-Raga, Mireia Feliu, Jaime J Clin Med Review Colorectal cancer (CRC) is one of the main causes of cancer death in the elderly. The older patients constitute a heterogeneous group in terms of functional status, comorbidities, and aging-related conditions. Therefore, therapeutic decisions need to be individualized. Additionally, a higher toxicity risk comes from the fact that pharmacokinetics and pharmacodynamics of the drugs as well as the tissue tolerance can be altered with aging. Although the chemotherapy efficacy in metastatic colorectal cancer (mCRC) is similar for older and young patients, more toxicity is presented in the elderly. While the mono-chemotherapy provides the same benefit for young and older patients, doublets front-line chemotherapy improves progression-free survival (PFS) but not overall survival (OS) in the elderly. Furthermore, the benefit of the addition of bevacizumab to chemotherapy in older patients has been shown in several clinical trials, while the clinical data for the benefit of anti-epidermal growth factor antibodies are scarcer. Immunocheckpoint inhibitors could be an appropriate option for patients with microsatellite instability (MSI) tumors. A prior geriatric assessment is required before deciding the type of treatment in order to offer the best therapeutic option. MDPI 2020-12-11 /pmc/articles/PMC7764481/ /pubmed/33322567 http://dx.doi.org/10.3390/jcm9124015 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Tuca, Albert
Gallego, Rosa
Ghanem, Ismael
Gil-Raga, Mireia
Feliu, Jaime
Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer
title Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer
title_full Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer
title_fullStr Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer
title_full_unstemmed Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer
title_short Chemotherapy and Targeted Agents in the Treatment of Elderly Patients with Metastatic Colorectal Cancer
title_sort chemotherapy and targeted agents in the treatment of elderly patients with metastatic colorectal cancer
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764481/
https://www.ncbi.nlm.nih.gov/pubmed/33322567
http://dx.doi.org/10.3390/jcm9124015
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