Is less always more?  Emerging treatment concepts in geriatric hemato-oncology

Nina Rosa Neuendorff; Hans Christian Reinhardt; Konstantinos Christofyllakis

doi:10.37155/2972-4759-2023-01-01-2

Authors

Nina Rosa Neuendorff Department for Hematology and Stem Cell Transplantation, University Hospital Essen, Hufelandstrasse 55, D-45147 Essen, Germany.
Hans Christian Reinhardt Department for Hematology and Stem Cell Transplantation, University Hospital Essen, Hufelandstrasse 55, D-45147 Essen, Germany.
Konstantinos Christofyllakis Department for Oncology, Hematology, Clinical Immunology and Rheumatology, Saarland University Medical School, Homburg/Saar, Germany

DOI:

https://doi.org/10.37155/2972-4759-2023-01-01-2

Keywords:

Cancer, Older adults, Comprehensive geriatric assessment, Chemotherapy, Sarcopenia, Undertreatment, Overtreatment

Abstract

The outcomes of older adults with cancer are still dismal despite some progress within the last years. This is mainly due to comorbidities, overall frailty, and differences in disease biology. The better understanding of tumor biology and immunology has enabled the use of targeted therapies and immunotherapies that are potentially better tolerated than traditional chemotherapies. Several randomized trials were recently published that demonstrated a benefit of integrated onco-geriatric care including geriatric interventions on treatment-related toxicities and quality of life during cancer treatment of older adults. Furthermore, other pivotal trials adapted treatment intensities based on frailty. Despite these efforts, older and frail adults are still underrepresented in clinical trials. This leads to a major lack of an evidence-based standard of care in geriatric oncology.

In this narrative review, we discuss pivotal trials, practical implications, under- and overtreatment, altered pharmacokinetics at older age, and future perspectives for geriatric oncology.

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