Pursuing our interest in the elderly, we sought to find out how first-line treatment might change if the patient were 80 years old rather than 60. Not unexpectedly, and as seen in other corners of oncology, treatment is generally less intense and more heterogeneous. Almost half of the GOs, including Dr Venook, use an FP alone or with a biologic, an approach that seems to make sense given the good outcomes in the AVEX trial evaluating capecitabine/bevacizumab. On the other hand, 
Dr Bendell and a not so insignificant minority of GOs cautiously administer FOLFOX/bevacizumab, but 
Dr Venook notes that most of the available trial data include relatively few older patients.

Cunningham D et al. Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): An open-label, randomised phase 3 trial. Lancet Oncol 2013;14(11):1077-85. Abstract

Hurwitz HI et al. Bevacizumab in combination with fluorouracil and leucovorin: An active regimen for first-line metastatic colorectal cancer. J Clin Oncol 2005;23(15):3502-8. Abstract

Seymour MT et al. Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): An open-label, randomised factorial trial. Lancet 2011;377(9779):1749-59. Abstract

Cassidy J et al. Effect of bevacizumab in older patients with metastatic colorectal cancer: Pooled analysis of four randomized studies. J Cancer Res Clin Oncol 2010;136(5):737-43. Abstract