Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA.
Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, 300 West 10th Avenue, Suite 519C, Columbus, OH 43210-1280, USA.
J Geriatr Oncol. 2013 Oct;4(4):295-301. doi: 10.1016/j.jgo.2013.07.007. Epub 2013 Aug 18.
The past decade has seen unprecedented advancements in our ability to treat patients with metastatic colorectal cancer. When applying these advances--hepatic resection and multi-agent chemotherapy--to the care of older patients, it is essential to first perform some assessment of function beyond performance status and to elicit feedback from the patient about how he/she values quality versus quantity of life. For robust older patients with potentially surgically resectable oligometastatic cancer, we recommend a standard approach of surgery with perioperative chemotherapy. However, operative risk increases with age, and careful discussion about prognosis is warranted. For patients with unresectable cancer, first-line chemotherapy with either 5-fluoruracil/leucovorin alone, or with a 20% dose reduced FOLFOX or FOLFIRI regimen, is well tolerated by older patients. Either dose escalation or addition of a second drug can typically be undertaken after 1-2 cycles. First-line bevacizumab with chemotherapy is warranted in those with low risk for atherothrombotic complications. EGFR inhibitors with combination chemotherapy for KRAS wild type cancers offer the best response rates, but toxicity can be difficult and may be best reserved for second-line in all but the fittest elderly. In second-line, we routinely offer continued chemotherapy with the agents that the patient has not yet received. The role of aflibercept and regorafenib has not been well studied in the elderly, but they are both reasonable options for patients with good function and no contraindication. With this cautious approach older patients can be expected to maintain a good quality of life during treatment for metastatic colorectal cancer.
过去十年，我们在治疗转移性结直肠癌患者方面取得了前所未有的进展。在将这些进展（肝切除术和多药物化疗）应用于老年患者的治疗时，首先必须对患者的功能进行除表现状态之外的评估，并征求患者对生活质量和数量的重视程度。对于潜在可手术切除的寡转移癌症的健壮老年患者，我们建议采用手术联合围手术期化疗的标准方法。然而，手术风险随年龄增加而增加，因此需要仔细讨论预后。对于无法切除的癌症患者，一线化疗可单独使用氟尿嘧啶/亚叶酸或低 20%剂量的 FOLFOX 或 FOLFIRI 方案，老年患者通常能很好地耐受。通常在 1-2 个周期后可进行剂量升级或添加第二种药物。对于有低动脉血栓栓塞并发症风险的患者，联合化疗加贝伐单抗是合理的。对于 KRAS 野生型癌症，联合化疗的 EGFR 抑制剂可提供最佳反应率，但毒性可能很困难，除了最健康的老年患者外，最好保留二线治疗。在二线治疗中，我们通常继续为尚未接受过治疗的患者提供联合化疗。阿柏西普和瑞戈非尼在老年患者中的应用尚未得到充分研究，但对于功能良好且无禁忌症的患者，它们都是合理的选择。通过这种谨慎的方法，老年患者在转移性结直肠癌的治疗期间可以保持良好的生活质量。
