Cancer predominantly occurs in older adults, with more than 60% of new cancer diagnoses and 70% of cancer-related deaths occurring in individuals aged 65 and above[
1]. Furthermore, as global life expectancy increases, the number of older adults requiring cancer therapy continues to rise. This presents as a major clinical challenge. However, evidence representing older adults in oncology trials remains limited, thereby restricting application in making decisions guiding treatments.
The study by Taylor et al. highlights the need for individualized evaluation beyond age, indicating that chronological age alone may not be a reliable predictor of tolerability or outcomes in older adults undergoing systemic cancer therapies[
2]. Both chemotherapy and immunotherapy show that patients aged > 75 years showed comparable tolerability, with similar discontinuation rates and toxicity profiles, challenging the traditional hesitation to treat older adults intensively. Moreover, upfront dose reductions are commonly used in chemotherapy and immunotherapy, and treatment efficacies are not significantly compromised[
2]. However, there is a persistent limitation in the lack of standardised, objective ways to differentiate fitness and frailty among older adults. This highlights the urgent need for validated geriatric assessment tools to individualize treatment while minimizing age-related bias.
This real-world study provides an optimistic view about treatment feasibility. Due to modified dose reductions, chemotherapy discontinuation rates were comparable to or better than those of some trial populations. Improved tolerability in routine care settings is highlighted by immunotherapy discontinuation rates that are either comparable to or lower than those observed in studies such as CheckMate-141[
3]. Furthermore, this study found no evidence that preemptive dose reduction led to any inferior outcomes or increased toxicity, which cautioned against arbitrary dose reductions due to concerns of reduced toxicity. These findings show the significance of individualized treatment decisions based on clinical judgment.
Additionally, an under-researched area in geriatric oncology was explored by providing valuable data on older adults receiving chemotherapy and immunotherapy in a regional Australian setting. Prior evidence suggests the population of older adults, especially those >75 years, is underrepresented in clinical trials, while there is a lack of data about diverse tumor types in remote areas of Australia; therefore, the research bridges a critical gap[
4]. Yet, there are limitations due to retrospective design and a small sample size of
n = 91, restricting causal inference and statistical power of the study. Furthermore, Eastern Cooperative Oncology Group (ECOG) performance status was lacking in 54% of the patients in the study cohort, and some assessments of frailty, such as G8 or CARG scores, were not collected at all. This hinders the ability to differentiate “fit” versus “frail” elderly in the study population. Lastly, objective toxicity grading scores should be adopted to ensure reproducibility and consistency.
Undoubtedly, this study brings forward real-world data challenging the traditional assumption of age being a limiting factor in cancer therapy. Chronological age proved to be a poor predictor of the outcome, with many older adults tolerating systemic therapy, while comorbidities contributed to poor prognosis, emphasizing the role of geriatric screening tools like G8 and CARG score, distinguishing fit patients from those needing dose adjustments. Notably, lower discontinuation rates with immunotherapy imply that it has greater tolerability compared with chemotherapy. These findings press the need for future prospective studies to better evaluate treatment tolerability in the aged oncology population.
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