Optimizing care for geriatric cancer patients: the greatest challenge in medical oncology?

Abstract

Fundamental progress has been achieved in the treatment of solid cancers over the last two decades and patients’ long-term outcome has improved accordingly. With monoclonal antibodies, small-molecule tyrosine kinase inhibitors and more recently, immune checkpoint modulators, a plethora of highly active novel drugs has become available. But are truly all patients benefitting from these successes? In an elderly population of breast cancer patients, the HER2positive subtype was still associated with the worst prognosis as shown in a recent publication [1] despite the excellent survival results achieved within clinical trials [2]. Indeed, optimization of the treatment of elderly patients may be the greatest challenge medical oncologists are facing today. Comorbid conditions, polypharmacy, decreased functional reserve, and age-related changes in pharmacokinetics result in impaired tolerability of anticancer drugs. Underrepresentation in clinical trials adds to this problem while, on the other hand, demographic changes with a growing older population results in an ever-increasing number of elderly cancer patients [3]. In their study published in this issue of MEMO, Balic et al. analyzed the prevalence of comorbid conditions in more than a thousand patients with solid cancer in Austria treated in 2011 [4]. With a median age of 64 years, the population represents clinical reality and clinically relevant comorbidities were present in 86% of patients. Not surprisingly, there was a significant association between the number of comorbid conditions and age (χ2 test; p< 0.001) and the vast ma-