Chemotherapie kolorektaler Karzinome im Alter

Zusammenfassung

Das kolorektale Karzinom ist mit einem mittleren Erkrankungsalter von knapp 70 Jahren überwiegend eine Erkrankung des höheren Lebensalters. Aus vorliegenden Studien zur Chemotherapie des kolorektalen Karzinoms zeigt sich, dass auch ältere Patienten sowohl von einer adjuvanten als auch palliativen zytostatischen Therapie profitieren. Im Vergleich zu jüngeren Patienten ist bei älteren Patienten in gutem Allgemeinzustand bei ähnlichem Therapieansprechen eine nur geringgradig erhöhte Toxizität zu erwarten.

Ältere Patienten sind in klinischen Studien deutlich unterrepräsentiert. Daher können die vorliegenden Daten nicht generell auf ältere Patienten mit kolorektalem Karzinom bezogen werden. Durch geriatrisches Assessment können therapierelevante Informationen zur besseren Patientenselektion erzielt werden. Auf der Grundlage eines solchen Assessments sollte bei der Vielzahl neuerer Medikamente, die derzeit in die Therapie des kolorektalen Karzinoms integriert werden, Wert darauf gelegt werden, geeignete ältere Patienten auch in klinischen Studien zu behandeln.

Abstract

With nearly 50 % of all colorectal cancers being diagnosed in patients at the age of 70 or above colorectal cancer is a disease of the elderly. In an adjuvant setting, fit elderly patients can receive the same benefit from cytotoxic therapy as younger patients with an only slightly increased toxicity.

In a palliative setting, the treatment of elderly patients with respect to clinical endpoints such as response, time to progression or overall survival is as effective as in their younger counterparts. In clinical studies, older patients are generally underrepresented and among the elderly patients involved in clinical studies there is a bias towards particularly fit patients. Therefore it is not possible to extrapolate the results of many randomized trials to all elderly patients. A Comprehensive Geriatric Assessment (CGA) should be applied to detect the diversities in the geriatric population. Based on this assessment elderly patients classified as suitable for chemotherapy should be enrolled into clinical trials for colorectal cancer.

Schlüsselwörter

Kolorektales Karzinom - Chemotherapie - Geriatrische Onkologie

Key words

colorectal cancer - chemotherapy - geriatric oncology

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