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In oncology clinical trials, elderly are often under-represented and this status quo still persists despite a clear need for efficacy data in this age category.1 This is due to several reasons: first, the survival age in the general population is increasing and so is the pool of subjects belonging to the older age. Second, many prevalent malignancies such as lung cancer are most often cancers of the elderly. Last but not least, the efficacy data for oncological therapies in the elderly might help a lot in better tailoring their management approach.
Among the causes related to the clinical study design, often exclusion criteria are represented by the presence of various comorbid chronic conditions and by poor performance (functional) status that are both attributes of ageing. However, can physical frailty be a major reason for avoiding cancer drugs in elderly? This perspective tries to make the case for the use of immune therapy in elderly with impaired functional status based on the available (even if limited) evidence and based on the premise that in such patients this approach can still have the potential to improve the quality of life as a palliative care approach.
Challenges in treating the frail elderly with cancer
Frailty or more specifically primary frailty is an attribute of the ageing and therefore can be considered as a geriatric phenotype. In fact the first definition of frailty was set up based on a number of features (Fried criteria, Box 1)2 which assess physical activity and its risk factors for impairment. Frailty can be diagnosed with the help of these criteria or by using derived scales such as the Clinical Frail Scale (CFS) for example. In a study performed in patients attending an oncology clinic (n=237), the CFS Score was able to predict survival and the probability to be discharged at home: a score …
Contributors SA: draft writing, topic proposal, draft structuring and draft revision. TSA: draft writing, draft structuring and draft revision. IA draft writing and revision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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