Review article: benefits and risks of chemotherapy in elderly patients with metastatic colorectal cancer R2.Mitry E, Rougier P. Aliment Pharmacol Ther. 2008 Oct 7. [Epub ahead of print] Background Although metastatic colorectal cancer (mCRC) is largely a disease of older individuals, our understanding of disease processes and their optimal treatment has been gained through trials with populations largely confined to younger individuals. Aim This review identifies issues specific to geriatric patients with mCRC (physiologic changes associated with aging, burden of coexisting illnesses, altered drug pharmacokinetics, functional impairment) and assessing challenges to elderly patients posed by malignancy and exposure to cytotoxic medication. Methods Our literature search for indexed articles published between 2000 and May 2008 employed terms including irinotecan, oxaliplatin, elderly, mCRC, targeted agents, and biologicals. Results Underrepresentation of older patients in clinical trials make it difficult to extrapolate findings to older age groups. However, some trials have demonstrated that elderly patients can achieve survival benefits and toxicity comparable to younger patients, although dosage modifications may be required. Conclusions Currently, benefits with pharmacologic therapy are suggested but not proven in the elderly population. Although concurrent illnesses and disabilities can complicate treatment decision making, chronologic age alone should not disqualify these patients with mCRC from receiving optimal treatment similar to that offered to their younger cohorts.