Treatment guidelines of metastatic colorectal cancer in older patients from the French Society of Geriatric Oncology (SoFOG)

• Published in: Digestive and liver disease 2020-05, Vol.52 (5), p.493-505
• Main Authors: Aparicio, Thomas, Canouï-Poitrine, Florence, Caillet, Philippe, François, Eric, Cudennec, Tristan, Carola, Elisabeth, Albrand, Gilles, Bouvier, Anne-Marie, Petri, Camille, Couturier, Bérengère, Phelip, Jean-Marc, Bengrine-Lefevre, Leila, Paillaud, Elena
• Format: Article
• Language: English
• Subjects: Aged; Chemotherapy; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Combined Modality Therapy; France; Humans; Life Sciences; Metastasis; Neoplasm Metastasis - diagnosis; Neoplasm Metastasis - pathology; Neoplasm Metastasis - therapy; Neoplasm Staging; Older patient; Quality of Life; Societies, Medical; Targeted therapy
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2019.12.145

Several guidelines dedicated to metastatic colorectal cancer (mCRC) are available. Since 2013 no recent guidelines are specifically dedicated to older patients and based on a systematic review. A multidisciplinary Task Force with digestive oncologists, geriatricians and methodologists from the SoFOG was formed in 2016 to update recommendations on medical treatment of mCRC based on a systematic review of publications from 2000 to 2018. Search strategy has followed a standardized protocol from the formulation of clinical questions and definition of a search algorithm to the selection of complete articles for recommendations. The four selected key questions were: For which older patients with mCRC can we considered: (1) Any chemotherapy, (2) Mono or poly-chemotherapy, (3) Anti-angiogenic therapy, (4) Other targeted therapy. Main recommendations for older patients are: (1) Omission of chemotherapy should be discussed with a geriatrician for patients with severe comorbidities, advanced dementia, uncontrolled psychiatric disorder or severe loss of autonomy. (2) If tumor response is not the main aim, a mono-chemotherapy with 5-fluorouracil combined with bevacizumab is recommended as first-line. (3) For patients with symptoms related to metastases or with a planned metastasis ablation, a doublet chemotherapy combined with bevacizumab or anti-EGFR antibody in the context of a RAS wild type tumor is recommended as first-line. Preliminary data suggest that regorafenib may be used, in its registered indication, in patients under 80 with a performance status of 0 and no autonomy alterations and that trifluridine-tipiracil may be used with a tight supervising of hematological function.