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Updates on the Management of Colorectal Cancer in Older Adults

Conor D J O'Donnell,Joleen Hubbard,Zhaohui Jin

Published 2024 in Cancers

ABSTRACT

Simple Summary The majority of cases of colorectal cancer occur in those over the age of 65. Treatment of colorectal cancer in older adults warrants specific considerations due to the effects of aging on comorbidities, functional and cognitive status, and socioeconomic factors. Several recent advances have been made to improve oncological outcomes and reduce toxicities with colorectal cancer treatments in both localized and metastatic disease settings. This review highlights the importance of comprehensive geriatric assessment and provides recommendations to guide the management of older adults with colorectal cancer. It summarizes prospective data from recently reported clinical trials focused on older adults. Other recommendations must at times rely on extrapolations and post hoc analyses due to the underrepresentation of older adults in colorectal cancer trials. This review should also, therefore, serve as a call to action for the field to increase the representation of this substantial and often vulnerable group of patients in future colorectal cancer trials. Abstract 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.

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