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Colorectal cancer is one of the most frequently diagnosed cancers in France and worldwide, with a peak incidence in patients over 70 years old, whose life expectancy is increasing. Long excluded from therapeutic trials, elderly patients are now the focus of special attention and dedicated studies. However, as treatment algorithms for metastatic colorectal cancer become increasingly complex, it is clear that a significant percentage of elderly colorectal cancer patients may not be receiving optimal treatment. The aim of this article is to review what is known about the treatment of metastatic colorectal cancer in the elderly and to discuss recent and ongoing advances.