Management of locally advanced and metastatic colon cancer in elderly patients

Table 3 Most common side effects of active agents in colon cancer and their management

Agent	Major side effects	Management
Fluoropyrimidine	Stomatitis, diarrhea, hand-foot syndrome	Identification and early symptom management
5-FU	Vomiting	Dose interuption or reduction if progression (grade 2 or worse)
Capecitabine	Pancytopenia	Adjustment of route of administration: bolus vs continuous infusion
		Predetermined treatment parameter
Oxaliplatin	Peripheral neuropathy (dose limiting)	Education about exposure to cold, dose modification, “stop and go” strategy, and use of neuromodulatory agents
	Pancytopenia	Predetermined treatment parameter
	Nausea, vomiting, diarrhea, fatigue	Identification and early symptom management.
		Dose interuption or reduction if progression (grade 2 or worse)
Irinotecan	Diarrhea	Premedication with atropine sulfate
	Pancytopenia	Proper instruction for the use of anti-motility agent to control diarrhea
		Predetermined treatment parameter
Anti EGFR	Skin toxicity (rash, dryness, pruritus)	Identification and early symptom management
Cetuximab	Mucositis	Proper instruction for the use of anti-motility agent to control diarrhea
Panitimumab	Diarrhea	Dose interuption or reduction if progression (grade 2 or worse).
Anti VEGF	Wound healing impairment	Blood pressure monitoring and adding anti-hypertensive agent if needed
Bevacizumab	Thromboembolism	Avoid in high risk patients.
Ziv-aflibercept	Bowel perforation	Close monitoring if used in patients at risk
	Proteinuria	Regular monitoring of urine protein secretion with urine dipstick or 24HR
	Hypertension	urine protein to creatinine ratio
		Holding medication prior to elective surgical procedure (6-8 wk)
		Appropriate healing time before re-starting medication post-op
Receptor TKI inhibitors	Hand-foot skin syndrome, rash	Identification and early symptom management
Regorafenib	Diarrhea, hypertension	Dose modification

5-FU: Fluorouracil; EGFR: Epidermal growth factor receptor; VEGF: Vascular endothelial growth factor; TKI: Tyrosine-kinase inhibitor.