Pharmacotherapy for older adults with cancer: a digest of the Japanese clinical practice guidelines (2nd edition)-general principles.

BACKGROUND: The global population is aging rapidly, and the incidence of cancer in older adults is increasing accordingly. However, older patients often present with complex clinical conditions that are not adequately reflected by chronological age or performance status alone, making the optimization of pharmacotherapy in this population a major challenge in oncology practice. METHODS: The Japanese Society of Medical Oncology and the Japanese Society of Clinical Oncology developed the second edition of the Clinical Practice Guidelines for Pharmacotherapy in Older Adults with Cancer in accordance with the Minds 2020 methodology. Systematic reviews, the Evidence-to-Decision framework, and multidisciplinary consensus processes were used to formulate recommendations. This article presents an English digest of the general principles section focusing on geriatric assessment (GA). RESULTS: Two clinical questions regarding the role of GA in pharmacotherapy decision-making were addressed. GA-based multidisciplinary management is conditionally recommended based on the evidence from randomized trials demonstrating a reduction in grade 3 or higher treatment-related toxicities, although the certainty of the evidence and feasibility of implementation remain limited. The use of GA to support treatment selection is also conditionally recommended. Although randomized trials did not show improved survival outcomes, studies integrating GA findings into shared decision-making demonstrated a reduction in severe treatment-related toxicities. Overall, GA appears to improve treatment safety and support individualized, patient-centered decision-making, although heterogeneity in intervention approaches and the limited certainty of the evidence precluded strong recommendations. CONCLUSIONS: These guidelines provide a framework for integrating GA into oncology practice. GA can help identify patient vulnerabilities, reduce treatment-related toxicity, and support individualized, patient-centered treatment decision-making. Further research is needed to establish optimal implementation strategies and strengthen the evidence base for geriatric oncology.