A significant proportion of patients presenting with colorectal cancer are elderly (over the age of 70 years). The Comprehensive Geriatric Assessment, which subdivides the population of elderly cancer patients into three groups, can help to guide treatment decisions. The group of "fit" elderly patients (good performance status or no significant comor-bidity) can tolerate a cytotoxic treatment and the use of systemic FU-based chemotherapy has been shown to be of clinical benefit for these patients with metastatic disease in terms of survival, control of symptoms and QoL.
A European analysis of 22 trials with 5-FU-con-taining treatment found the same survival and response rate in elderly and in younger patients, while progression-free survival was marginally prolonged in the elderly . In a North American analysis of 4 trials testing 5-FU with or without LV, performance status, not age, has been predictive of time to tumour progression and overall survival; elderly patients treated with 5-FU have modestly higher rates of severe toxicity, mainly diarrhoea and stomatitis .
Data from the first clinical trials regarding the use of new drugs (oxaliplatin, irinotecan, raltitrexed, oral fluoropyrimidines) in selected elderly patients are limited but indicate an activity comparable to that observed in younger patients, with overall manageable toxicity.
In conclusion, standardised palliative chemotherapy should generally be offered to fit elderly patients and they should not be excluded from clinical trials in order to gain information about new treatments.
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