Because older patients are underrepresented in clinical trials and very little data exists on how treatments for GI cancers affect this patient population, doctors shy away from prescribing standard regimens.   Physician fear of high toxicity levels of standard regimens may affect treatment decision-making for older adults.

  • A Pooled Analysis of Adjuvant Chemotherapy for Resected Colon Cancer in Elderly Patients: Whether a patient with resected colon cancer receives postsurgical adjuvant chemotherapy and what type typically depends on the cancer’s stage. In this New England Journal of Medicine article, researchers detail their analysis of several studies comparing the effects of standard therapies for adjuvant treatment for older adults. The authors found that fit older adults received similar benefit with adjuvant 5-florouracil when compared to their younger counterparts without a significant increase in toxicity.   
  • Pooled Analysis of Safety and Efficacy of Oxaliplatin Plus Fluorouracil/Leucovorin Administered Bimonthly in Elderly Patients With Colorectal Cancer: Researchers analyzed four clinical trials of bimonthly adjuvant, first-line, and second-line FOLFOX4 in patients age 70 and younger and age 70 and older. They studied the occurrence of grade 3 or higher adverse events; progression-free, relapse-free, and overall survival; and dose intensity and found that FOLFOX4 is as safe and effective for most older patients who were enrolled onto clinical trials as it is for younger patients. When making the decision to treat older patients with FOLFOX4, researchers recommend factoring in performance status, comorbidity status, and social factors and communicating benefits and risks to patients.
  • Bevacizumab in Elderly Patients With Metastatic Colorectal Cancer: Doctors have traditionally undertreated older patients with metastatic colorectal cancer, fearing high toxicities from systemic therapies. In this Journal of Geriatric Oncology article, authors discuss their analysis that found that bevacizumab affects older patients with metastatic colorectal cancer similarly—in regard to safety and clinical benefit—to how it affects younger patients, although older adults are at increased risk of arterial thromboembolic events.
  • Chemotherapy Options in Elderly and Frail Patients With Metastatic Colorectal Cancer (MRC FOCUS2): An Open-Label, Randomised Factorial Trial: In this Lancet article, researchers discuss the FOCUS2 trial, which studied older patients with previously untreated colorectal cancer who were not able to undergo full-dose chemotherapy due to their age and/or frailty. They found that older and/or frail adults still benefited from treatment when starting doses were reduced.