Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
J Clin Oncol. 2023 Dec 1;41(34):5228-5236. doi: 10.1200/JCO.23.01337. Epub 2023 Oct 19.
Journal of Clinical OncologyColorectal cancer (CRC) is the second leading cause of cancer-related death in the United States with more than half of the patients diagnosed being older than 65 years, and an expected further increase in older adults (OA) diagnosed with this cancer in the coming years as the population ages. Prospective data guiding the management of older patients with metastatic CRC (mCRC) have been limited and treatment decisions for these patients are often guided by chronologic age, crude evaluation of performance status, and extrapolation from trials conducted in younger individuals. Recent evidence from randomized clinical trials specifically designed for OA supports treatment deintensification and dose modification to increase tolerability without compromising efficacy in older, frailer patients with mCRC. Additional studies support the incorporation of geriatric assessment (GA)-driven care to further improve the outcomes of OA with mCRC. Although the use of GA has not been validated in guiding specific treatment selection or modification for OA with mCRC, it provides a comprehensive and objective evaluation of a patient's functional status, comorbidities, risk of potential toxicities, effect on the quality of life, goals of care, and assists with personalizing therapy. With the increase in the number of OA we care for in our practices, it is time to stop extrapolating and define an evidence-based approach for this population that is based on data from prospective elderly specific clinical trials.
临床肿瘤学期刊 结直肠癌（CRC）是美国癌症相关死亡的第二大主要原因，超过一半的诊断患者年龄大于 65 岁，预计未来几年随着人口老龄化，患有这种癌症的老年患者（OA）将进一步增加。指导转移性结直肠癌（mCRC）老年患者管理的前瞻性数据有限，这些患者的治疗决策通常受年龄、体力状态的粗略评估以及从年轻个体进行的试验外推的影响。最近专门为 OA 设计的随机临床试验的证据支持治疗减量化和剂量调整，以提高不耐受性，而不会降低脆弱的 mCRC 老年患者的疗效。其他研究支持纳入老年评估（GA）驱动的护理，以进一步改善 mCRC 的 OA 结局。尽管 GA 的使用尚未在指导 mCRC 的 OA 特定治疗选择或调整方面得到验证，但它提供了患者功能状态、合并症、潜在毒性风险、对生活质量的影响、治疗目标的全面和客观评估，并有助于个性化治疗。随着我们在实践中护理的 OA 数量的增加，是时候停止外推并基于前瞻性老年特定临床试验的数据为这一人群定义循证方法了。
