Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, AP-HP, University of Paris, Paris, France.
Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France.
Dig Liver Dis. 2020 May;52(5):493-505. doi: 10.1016/j.dld.2019.12.145. Epub 2020 Feb 3.
Several guidelines dedicated to metastatic colorectal cancer (mCRC) are available. Since 2013 no recent guidelines are specifically dedicated to older patients and based on a systematic review.
A multidisciplinary Task Force with digestive oncologists, geriatricians and methodologists from the SoFOG was formed in 2016 to update recommendations on medical treatment of mCRC based on a systematic review of publications from 2000 to 2018. Search strategy has followed a standardized protocol from the formulation of clinical questions and definition of a search algorithm to the selection of complete articles for recommendations.
The four selected key questions were: For which older patients with mCRC can we considered: (1) Any chemotherapy, (2) Mono or poly-chemotherapy, (3) Anti-angiogenic therapy, (4) Other targeted therapy. Main recommendations for older patients are: (1) Omission of chemotherapy should be discussed with a geriatrician for patients with severe comorbidities, advanced dementia, uncontrolled psychiatric disorder or severe loss of autonomy. (2) If tumor response is not the main aim, a mono-chemotherapy with 5-fluorouracil combined with bevacizumab is recommended as first-line. (3) For patients with symptoms related to metastases or with a planned metastasis ablation, a doublet chemotherapy combined with bevacizumab or anti-EGFR antibody in the context of a RAS wild type tumor is recommended as first-line. Preliminary data suggest that regorafenib may be used, in its registered indication, in patients under 80 with a performance status of 0 and no autonomy alterations and that trifluridine-tipiracil may be used with a tight supervising of hematological function.
有一些专门针对转移性结直肠癌（mCRC）的指南。自 2013 年以来，没有专门针对老年患者的最新指南，也没有基于系统评价。
2016 年，SoFOG 的消化肿瘤学家、老年病学家和方法学家组成了一个多学科工作组，以根据 2000 年至 2018 年发表的文献进行系统评价，更新 mCRC 治疗的建议。搜索策略遵循标准化协议，从制定临床问题和定义搜索算法到为建议选择完整文章。
选择了四个关键问题：对于哪些患有 mCRC 的老年患者，我们可以考虑：（1）任何化疗，（2）单药或多药化疗，（3）抗血管生成治疗，（4）其他靶向治疗。对老年患者的主要建议是：（1）对于严重合并症、晚期痴呆、无法控制的精神障碍或严重丧失自主能力的患者，应与老年病医生讨论是否应避免化疗。（2）如果肿瘤反应不是主要目标，则推荐使用氟尿嘧啶联合贝伐珠单抗的单药化疗作为一线治疗。（3）对于有转移相关症状或计划进行转移消融的患者，建议在 RAS 野生型肿瘤的背景下使用联合贝伐珠单抗或抗 EGFR 抗体的双联化疗作为一线治疗。初步数据表明，regorafenib 可在其注册适应症下用于无自主能力改变且身体状况为 0 级和 80 岁以下的患者，trifluridine-tipiracil 可在严格监测血液学功能的情况下使用。
