O'Donnell Conor D J, Hubbard Joleen, Jin Zhaohui
Mayo Clinic School of Graduate Education, Mayo Clinic College of Medicine and Science, Mayo Building, Rochester, MN 55905, USA.
Allina Health Cancer Institute, Minneapolis, MN 55407, USA.
Cancers (Basel). 2024 May 10;16(10):1820. doi: 10.3390/cancers16101820.
Colorectal cancer (CRC) poses a significant global health challenge. Notably, the risk of CRC escalates with age, with the majority of cases occurring in those over the age of 65. Despite recent progress in tailoring treatments for early and advanced CRC, there is a lack of prospective data to guide the management of older patients, who are frequently underrepresented in clinical trials. This article reviews the contemporary landscape of managing older individuals with CRC, highlighting recent advancements and persisting challenges. The role of comprehensive geriatric assessment is explored. Opportunities for treatment escalation/de-escalation, with consideration of the older adult's fitness level. are reviewed in the neoadjuvant, surgical, adjuvant, and metastatic settings of colon and rectal cancers. Immunotherapy is shown to be an effective treatment option in older adults who have CRC with microsatellite instability. Promising new technologies such as circulating tumor DNA and recent phase III trials adding later-line systemic therapy options are discussed. Clinical recommendations based on the data available are summarized. We conclude that deliberate efforts to include older individuals in future colorectal cancer trials are essential to better guide the management of these patients in this rapidly evolving field.
结直肠癌（CRC）是一项重大的全球健康挑战。值得注意的是，CRC的风险随年龄增长而上升，大多数病例发生在65岁以上的人群中。尽管近期在针对早期和晚期CRC的治疗定制方面取得了进展，但缺乏前瞻性数据来指导老年患者的管理，这些患者在临床试验中的代表性往往不足。本文回顾了老年CRC患者管理的当代情况，强调了近期的进展和持续存在的挑战。探讨了综合老年评估的作用。在结肠癌和直肠癌的新辅助、手术、辅助和转移治疗环境中，考虑老年患者的身体状况，对治疗强化/弱化的机会进行了综述。免疫疗法被证明是患有微卫星不稳定CRC的老年患者的一种有效治疗选择。讨论了循环肿瘤DNA等有前景的新技术以及增加后线全身治疗选择的近期III期试验。总结了基于现有数据的临床建议。我们得出结论，在未来的结直肠癌试验中有意纳入老年个体对于在这个快速发展的领域更好地指导这些患者的管理至关重要。
