Japanese clinical practice guidelines for pharmacotherapy in older adults with cancer (second edition): an overview

The global population is aging rapidly, and the number of older adults with cancer is increasing worldwide. However, evidence supporting optimal pharmacotherapy for this population remains limited because older adults are frequently underrepresented in clinical trials. Therefore, we aimed to develop evidence-based clinical practice guidelines for pharmacotherapy in older adults with cancer.

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, incorporating systematic reviews, the Evidence-to-Decision framework, and multidisciplinary consensus processes.

The guideline addressed 17 clinical questions across hematologic and major solid tumors within a cross-organ framework. Most recommendations were classified as conditional because of the limited availability of high-quality evidence specific to older adults and the need to consider the balance between benefits and harms, patient values and preferences, treatment burden, and resource use. Only one recommendation was classified as strong. The guidelines emphasize individualized treatment approaches integrating patient characteristics, including functional status, comorbidities, life expectancy, and patient preferences, rather than relying solely on chronological age.

These guidelines provide a cross-organ, pharmacotherapy-focused framework for managing older adults with cancer. Developed in the most rapidly aging society, they provide clinically relevant insights and evidence-based recommendations for oncology practice and highlight the importance of integrating geriatric principles into treatment decision-making. They also underscore the urgent need for clinical trials targeting older adults to strengthen the evidence base in geriatric oncology.