While many GOs generally opt for a less intense induction regimen for an 80-year-old patient, their approach to maintenance is fundamentally similar to that taken with younger patients. Most GOs will continue the FP and the biologic (if used) until disease progression or toxicity, and if they choose oxaliplatin or irinotecan they will limit the duration. Dr Bendell favors this approach and also notes that maintenance therapy for the elderly may be more complicated, particularly for patients with comorbidities. In contrast, Dr Venook leans toward single-agent capecitabine until disease progression in this population.

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

McCleary NJ et al. Safety and effectiveness of oxaliplatin-based chemotherapy regimens in adults 75 years and older with colorectal cancer. Clin Colorectal Cancer 2013;12(1):62-9. Abstract

Cassidy J et al. First-line oral capecitabine therapy in metastatic colorectal cancer: A favorable safety profile compared with intravenous 5-fluorouracil/leucovorin. Ann Oncol 2012;13(4):566-75. Abstract