What is the general approach to dosing of chemotherapy in elderly patients?

• A. Assess physiologic age, comorbidities, organ function; adjust dose and schedule to balance efficacy and tolerability; monitor closely for toxicity.
• B. Always give standard adult dose.
• C. Discontinue chemotherapy in all elderly.
• D. Use only palliative regimens.

Answer: (A)

Dosing chemotherapy in older adults is about tailoring therapy to the individual’s physiologic reserve, comorbidities, and organ function to maximize benefit while minimizing harm. As people age, kidney and liver function, bone marrow reserve, and drug handling can change, and many have other health conditions or taking multiple medications that raise the risk of interactions and toxicity. Because of these factors, starting with a dose and schedule that are adjusted from standard recommendations, and then watching closely for side effects, gives the best chance of having meaningful treatment effects without overwhelming toxicity. This approach also leaves room to modify plans based on how well the patient tolerates treatment, changes in organ function, or shifts in goals of care.

Giving the standard adult dose ignores age-related changes and can lead to unnecessary toxicity. Discontinuing chemotherapy in all elderly ignores individual variation in fitness and goals, and using only palliative regimens overlooks situations where adjusted regimens might still offer disease control or symptom relief. The best practice is individualized treatment planning that weighs potential benefits against risks for each patient, with ongoing assessment and adjustment as needed.