Personalized Chemotherapy for Colorectal Cancer in Elderly Patients

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• Age, Fitness, and Treatment Decisions
• Chemotherapy Efficacy in the Elderly
• Managing Chemotherapy Side Effects
• Personalized Dosing Strategy
• The Importance of Expert Care
• Full Transcript

Age, Fitness, and Treatment Decisions

Dr. Hans-Joachim Schmoll, MD, emphasizes that chronological age is a poor indicator for colorectal cancer treatment planning. The term "elderly" encompasses a vast spectrum of health states. A 70-year-old patient might be highly active and physically robust, while another may have significant mobility issues and multiple comorbidities. Dr. Schmoll clarifies that the critical factor is a patient's physical fitness, which is a combination of genetics, lifestyle, and co-existing health problems. This fitness level, rather than the number of years lived, should guide all therapeutic decisions for colorectal cancer.

Chemotherapy Efficacy in the Elderly

Clinical evidence confirms that fit elderly patients benefit from chemotherapy to the same degree as their younger counterparts. Dr. Hans-Joachim Schmoll, MD, references clinical trials that included patients up to 84 years of age. The data shows that the efficacy of systemic chemotherapy in achieving positive outcomes for stage 3 colon cancer is maintained in this population. Dr. Anton Titov, MD discusses how this research has shifted treatment paradigms. The current recommendation is to offer elderly patients with colorectal cancer the same treatment regimens as younger patients, provided their individual fitness level supports it.

Managing Chemotherapy Side Effects

While efficacy is maintained, the risk of complications and side effects from chemotherapy can be higher in some elderly patients. Dr. Hans-Joachim Schmoll, MD, notes that a patient's tolerance is influenced by factors like metabolic activity and DPD enzyme function. This enzyme is crucial for processing common colorectal cancer chemotherapy drugs like 5-fluorouracil and capecitabine. A personalized approach is essential to mitigate toxicity risk while preserving the treatment's anti-cancer benefits. Careful monitoring allows oncologists to manage these risks effectively.

Personalized Dosing Strategy

A key strategy for optimizing colorectal cancer treatment in the elderly is dose modification. Dr. Hans-Joachim Schmoll, MD, outlines an accepted practice of starting chemotherapy at a reduced dose, potentially as low as 30% of the standard dose. The patient is then closely observed for any signs of toxicity. If the treatment is well-tolerated, the dose can be carefully escalated. This method allows physicians to find the most effective and safest dose for each individual patient, ensuring they can receive the full benefit of therapy without undue harm.

The Importance of Expert Care

Dr. Anton Titov, MD and Dr. Hans-Joachim Schmoll, MD, conclude that precision medicine is paramount for elderly colorectal cancer care. A comprehensive treatment review must carefully weigh all factors, including co-morbidities and overall fitness. This complex decision-making process underscores the necessity for management by experienced colon cancer specialists. Withholding potentially curative full-dose chemotherapy based solely on a patient's age is an outdated and incorrect practice. Every treatment plan must be highly individualized to provide the best possible outcome.

Full Transcript

Dr. Anton Titov, MD: 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?

Over 50% of colorectal cancer is diagnosed in patients over 70 years of age. 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?

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 ages. There is a huge difference in patients of 70, 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.

A patient with colorectal cancer may be biologically 70 or over 70 years of age. But the patient can be physically 20 or 30 years younger. We should treat him like a patient who is younger. Sometimes an elderly colon cancer patient's physical state is worse. Sometimes he has many concurrent medical problems.

Then it is harder to treat colon cancer. It is a fitness question, not a biology question. How physically fit the patient is. That fitness is also biology. It is based on the natural component and lifestyle of the patient. Fitness depends on his genes.

Dr. Anton Titov, MD: Fitness also depends on co-morbidities at any given age of patient.

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. The oldest patient with colon cancer in our clinical trial was 84. 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.

Dr. Hans-Joachim Schmoll, MD: 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. But we can find out how well a 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 the patient does not show side effects of chemotherapy. We can see if there is no toxicity risk after starting the chemotherapy.

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.

A patient with colorectal cancer may be biologically 70 or over 70 years of age. But the patient can be physically 20 or 30 years younger.