title: Angiogenic inhibitors for older patients with advanced colorectal cancer: does the age hold the stage?
abstract: Although major progress has been achieved in the treatment of advanced colorectal cancer (CRC) with the employment of antiangiogenic agents, several questions remain on the use of these drugs in older patients. Since cardiovascular, renal and other comorbidities are common in the elderly, an accurate assessment of the patients' conditions should be performed before a treatment decision is made. Since most CRC patients enrolled in clinical trials testing antiangiogenic drugs were aged < 65 years, the efficacy and tolerability of these agents in elderly patients has not been adequately explored. Data suggest that patients with advanced CRC derive similar benefit from bevacizumab treatment regardless of age, but the advantage of other antiangiogenic drugs in the same class of patients appears more blurred. Literature data suggest that specific antiangiogenic-related toxicities such as hypertension or arterial thromboembolic events may be higher in the elderly than in the younger patients. In addition, it should be emphasized that the patients included in the clinical studies discussed herein were selected and therefore may not be representative of the usual elderly population. Advanced age alone should not discourage the use of bevacizumab. However, a careful patients' selection and watchful monitoring of toxicities are required to optimize the use of antiangiogenics in this population.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
authors.forename: Caterina
authors.initials: C
authors.lastname: Fontanella
authors.forename: Eufemia Stefania
authors.initials: ES
authors.lastname: Lutrino
authors.forename: Laura
authors.initials: L
authors.lastname: Ferrari
authors.forename: Mariaelena
authors.initials: M
authors.lastname: Casagrande
authors.forename: Giovanni Gerardo
authors.initials: GG
authors.lastname: Cardellino
authors.forename: Gerardo
authors.initials: G
authors.lastname: Rosati
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Fasola
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors
keywords: Advanced colorectal cancer; Antiangiogenesis; Bevacizumab; Chemotherapy; Elderly