Half of all colorectal cancer is diagnosed in elderly people over 70 years of age. How does age affect treatment options in colorectal cancer? How to approach chemotherapy combination in elderly patients with colon cancer or rectal cancer?
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Over 50% of colorectal cancer is diagnosed in patients over 70 years of age. Dr. Anton Titov, MD. There are nuances in colon cancer treatment in elderly patients. Efficacy of certain systemic chemotherapy medications in elderly patients with colon cancer has been debated. Dr. Anton Titov, MD. What systemic chemotherapy treatments work best in stage 3 colon cancer in elderly patients? What are the factors that determine the selection for colon cancer chemotherapy in elderly patients? Prof. Dr. Hans-Joachim Schmoll, MD. We do not have an exact definition of age in colon cancer. “Over 70 years of age” can mean different age. There is a huge difference in the patients of 70 or 75 or 80 years of age with colorectal cancer. One “over 70” patient comes just from the tennis court and says: “Oh, sorry, I have colon cancer”. Another elderly patient with colon cancer has poor mobility and many medical problems, like heart problems. There are many different possibilities in between these extremes The patient with colorectal cancer may be biologically 70 or over 70 years of age. But patient can be physically 20 or 30 years younger. we should treat him like a patient who is younger. Sometimes elderly colon cancer patient’s physical is worse. Sometimes he has many concurrent medical problems. Prof. Dr. Hans-Joachim Schmoll, MD. Then it is harder to treat colon cancer. It is a fitness question, not the biology question. How physically fit the patient is. That fitness is also biology. It is based on the natural component and life style of the patient. Fitness depends on his genes. Dr. Anton Titov, MD. Fitness also depends on co-morbidities at any given age of patient. Prof. Dr. Hans-Joachim Schmoll, MD. Yes, physical fitness of colon cancer elderly patients is one factor. But genes affect fitness. Colorectal cancer treatment decisions are individualized for each elderly patient. We showed this in patients over 70 with colon cancer. oldest patient with colon cancer in our clinical trial was 84. Prof. Dr. Hans-Joachim Schmoll, MD. These elderly patients with colorectal cancer had the same benefit of treatment as younger patients. There might be more complications and side effects from colon cancer chemotherapy. But the recommendation is now that we treat colorectal cancer in elderly patients just as in younger patients. Dr. Anton Titov, MD. Sometimes there are health problems, we adapt chemotherapy doses for each patient. We can start with a lower dose. In particular, doses of 5-fluorouracil and capecitabine in elderly patients depend on metabolic activity. Chemotherapy efficacy also depends on DPD enzyme activity in colon cancer tumor. [We discussed that earlier.] But we can find out how well patient tolerates chemotherapy. We start with a lower dose of colon cancer chemotherapy. For example, we can start at 30% dose of the chemotherapy. Then we can escalate the dose if patient does not show side effects of chemotherapy. We can see if there is no toxicity risk after starting the chemotherapy. Prof. Dr. Hans-Joachim Schmoll, MD. Then the patient can have the full dose and benefit of colon cancer chemotherapy treatment. this is an accepted practice. Treatment of elderly patients over 70 years of age should be based on individual decisions for each patient. Dr. Anton Titov, MD. But it is not correct to withhold full dose chemotherapy for elderly patients with colorectal cancer. Colorectal cancer therapy in elderly patients over 70 years of age. How to choose chemotherapy based on fitness of patient? Treatment for older people with bowel cancer has to be personalized based on individual physical fitness. Biological age means little without fitness consideration. How Should We Care for Elderly Cancer Patients? We must treat each patient with colon cancer individually. colorectal cancer treatment review has to take into consideration co-morbidities and fitness. treatment of bowel cancer in the elderly must be done by best colon cancer experts to select precision medicine therapy. patient with colorectal cancer may be biologically 70 or over 70 years of age. But patient can be physically 20 or 30 years younger.