ESMO E-Learning:  Management of Colorectal Cancer in Older Adults

In this E-Learning module, the authors tackle controversies regarding the management of older patients, the gap in knowledge between patients included in the randomised trials and real-world population, the importance of in-depth assessment of both, the tumour and the patient, as well as the other factors influencing the care, and contextualise the findings from the trials in the adjuvant and metastatic settings, important for the management of older patients with colorectal cancer.

Starting from the benefit of adjuvant chemotherapy in the general population of patients with colorectal cancer, the authors further elaborate on the benefit of adjuvant chemotherapy in older patients with stage III disease, specifically the benefit from oxaliplatin; they provide findings from a pooled analysis of clinical trials, especially in terms of time-to-recurrence according to age and treatment duration, deep into potential approaches in case of fit and unfit patients for doublet chemotherapy, tackle the prospect of ongoing trials and give details about the findings in stage II colorectal cancer and the pragmatic approach for patients older than 70 years.

In the next chapter, the authors elaborate on how to treat older patients with metastatic colorectal cancer and the findings from clinical trials dedicated to older patients or the analysis from trials that looked into such subset of patients and tested chemotherapy, chemotherapy with or without bevacizumab, EGFR inhibitors, chemotherapy plus EGFR inhibitors, EGFR inhibitor added to doublet chemotherapy; findings from trials in BRAF-mutated metastatic tumours, immune checkpoint inhibitor monotherapy versus chemotherapy, treatment with combined immune checkpoint inhibitors versus chemotherapy, and treatment in third-line setting.

The authors point out that dedicated randomised clinical trials are needed to evaluate the real value of cancer drugs in unselected/vulnerable older adults. They advocate for patient-centred endpoints as (co)-primary endpoint(s), patient stratification based on geriatric assessment and underline that geriatric assessment guided interventions are feasible.