Naoya Ishibashi, Masayuki Ueno, Shigeki Kataoka, Ayako Doi, Chie Tanaka, Osamu Maeda, Tetsuya Hamaguchi, Junichi Nakazawa, Fumio Nagashima, Ayumu Matsuoka, Akitaka Makiyama, JSMO/JSCO Clinical Practice Guideline Committee for Pharmacotherapy in Older Adults with Cancer
These guidelines provide practical evidence-informed recommendations for pharmacotherapy in older adults with gastrointestinal cancers. They emphasize individualized treatment strategies that integrate patient characteristics, treatment goals, and tolerability. Further research, specifically targeting older populations, is required to strengthen the evidence base in geriatric oncology.
BACKGROUND: The number of older adults with gastrointestinal cancers is increasing in rapidly aging societies. However, optimal pharmacotherapy for this population remains challenging because of heterogeneity in functional status, comorbidities, and the limited representation of older patients in clinical trials.
METHODS: This article presents an English digest of the Japanese Clinical Practice Guidelines for Pharmacotherapy in Older Adults with Cancer (second edition) [5] with a focus on gastrointestinal cancers. The guidelines were developed in accordance with the Minds 2020 methodology, incorporating systematic reviews, the Evidence-to-Decision framework, and multidisciplinary consensus.
RESULTS: The guideline addresses key clinical questions regarding systemic therapy for older patients with gastric and colorectal cancers, including combination chemotherapy, biomarker-guided therapy, and adjuvant treatment strategies. All recommendations were conditional because of limited direct evidence in older populations. Specifically, in gastric cancer, oxaliplatin-containing combination therapy and biomarker-guided treatment may be considered for appropriately selected patients and are conditionally recommended. In colorectal cancer, routine treatment intensification with oxaliplatin- or irinotecan-containing regimens is not uniformly recommended. Treatment decisions should be individualized by weighing the expected benefit against the risk of increased toxicity, particularly in frail or very old patients.
CONCLUSIONS: These guidelines provide practical evidence-informed recommendations for pharmacotherapy in older adults with gastrointestinal cancers. They emphasize individualized treatment strategies that integrate patient characteristics, treatment goals, and tolerability. Further research, specifically targeting older populations, is required to strengthen the evidence base in geriatric oncology.