Place of anti-EGFR therapy in older patients with metastatic colorectal cancer in 2020. Issue 8 (November 2020)

• Record Type: Journal Article
• Authors: Gilabert, Marine; Ries, Pauline; Chanez, Brice; Triby, Simon; Francois, Eric; Lièvre, Astrid; Rousseau, Frederique
• Is Part Of: Journal of geriatric oncology. Volume 11:Issue 8(2020)
• Page Start: 1229
• Page End: 1236
• Publication Date: 2020-11
• Subjects: Anti-EGFR -- Older patients -- Metastatic colorectal cancer; mCRC Metastatic Colorectal Cancer -- SIOG International Society of Geriatric Oncology -- CGA Comprehensive Geriatric Assessment -- FPs Fluoropyrimidines -- EGFR Epidermal Growth Factor Receptor -- CRASH Chemotherapy Risk Assessment Scale for High-Age Patients -- MMSE Mini Mental Status Examination -- IADL Instrumental Activities of Daily Living -- GDS Geriatric Depression Scale -- ORR Objective Response Rate -- OS Overall Survival -- PFS Progression-Free Survival; Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2020.04.004
• Languages: English
• ISSNs: 1879-4068

Abstract

Abstract: Almost half of the new cases of colorectal cancer concern patients aged ≥70 years. However, very few clinical trials have specifically included older patients. As a consequence, the treatment of these patients is controversial because the balance between clinical benefits and toxicities remains uncertain. In patients without comorbidities and with an ECOG performance score of 0–1, treatment indications are similar to those of younger patients. For frail patients, chemotherapy is possible, but a comprehensive geriatric assessment is recommended. Anti-EGFR (epidermal growth factor receptor) therapy is indicated either in combination with chemotherapy in the first-line or second-line setting or as monotherapy in the third-line setting (i.e., after failure of chemotherapy). For fit older patients, clinical trials that compared chemotherapy alone with doublet chemotherapy plus anti-EGFR in either first-line or second-line setting suggested that age is not an absolute contraindication for the use of this regimen. In frail patients, anti-EGFR monotherapy in the first-line, second-line or third-line setting has shown feasibility and antitumor activity and had mainly cutaneous toxicities that were easily managed. In any case, administration of treatment must be very cautious in older patients and the treatment dose needs to be adapted according to comorbidities.