Department of Pharmacy Clinical Programs, U.T. M.D. Anderson Cancer Center, Houston, TX, USA.
Department of Medicine Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
Expert Opin Pharmacother. 2019 Dec;20(17):2139-2160. doi: 10.1080/14656566.2019.1657826. Epub 2019 Aug 28.
: Oncology care in the elderly presents a dilemma. The majority of cancer cases are diagnosed in the elderly yet they are underrepresented in clinical trials. In addition to limited evidence-based medicine, the elderly is a heterogeneous population filled with pharmacotherapeutic challenges and barriers. Elderly metastatic colorectal cancer (mCRC) treatment decisions encompass these challenges.: Treatment based solely on chronological age is an unacceptable practice. Physiologic factors such as function, cognition, comorbidities, polypharmacy, among others must be considered. Oncology guidelines emphasize using a geriatric assessment (GA) as opposed to traditional oncology performance status measures to best identify risks. Our review shines light on these issues as they pertain to elderly unresectable metastatic colorectal cancer (mCRC).: The practical use of GA tools in oncology remain to be determined. Current barriers are the lack of a consistent tool to unify decision-making, provider education, and evidence-based use/outcomes in specific cancers. mCRC antineoplastic data surrounding GAs are scarce, and current mCRC national treatment algorithms are not stratified to encompass GA-driven therapy. Therefore, providers lack clear guidance or practicality of use. We hope mCRC trial designs will abandon age cutoffs and instead place more focus on GAs for inclusion and outcomes.
老年肿瘤学面临困境。大多数癌症病例发生在老年人中，但他们在临床试验中的代表性不足。除了有限的循证医学证据外，老年人是一个充满药物治疗挑战和障碍的异质人群。老年转移性结直肠癌（mCRC）的治疗决策包含了这些挑战。
单纯基于年龄的治疗是不可接受的做法。必须考虑生理因素，如功能、认知、合并症、多药治疗等。肿瘤学指南强调使用老年综合评估（GA），而不是传统的肿瘤学表现状态测量，以最好地识别风险。我们的综述重点介绍了这些与老年不可切除转移性结直肠癌（mCRC）相关的问题。
GA 工具在肿瘤学中的实际应用仍有待确定。目前的障碍是缺乏统一的决策工具、提供者教育以及特定癌症中基于证据的使用/结果。GA 周围的 mCRC 抗肿瘤数据稀缺，目前的 mCRC 国家治疗算法也没有分层来包含 GA 驱动的治疗。因此，提供者缺乏明确的指导或实用性。我们希望 mCRC 试验设计将放弃年龄截止点，而更多地关注 GA 的纳入和结果。
