Gastric cancer is considered an age-related disease, with the majority of new cases in the UK diagnosed in individuals over the age of 75. At present most guidance related to the management of gastric cancer is based on trials undertaken in the fit, younger patient. Historically the elderly have been underrepresented in clinical trials, which frequently have a restricted inclusion to an upper age limit of 75. The European Society for Medical Oncology (ESMO) recommends use of a geriatric assessment to determine functional age when initiating treatment in elderly patients with gastric cancer, which has been shown to be a better predictor of treatment response than chronological age. The physiological changes that occur with age, including reduced organ function and pharmacokinetic and pharmacodynamic variability, together with impaired functional status, necessitate a more individualised approach to treatment decisions in the older patient to provide them with the same advantages from radical treatment and palliative chemotherapy as younger patients. This review summarises the current evidence extrapolated from trial data on how best to optimise treatment for elderly patients with gastric cancer.

中文翻译：

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老年患者治疗胃癌的挑战。

胃癌被认为是一种与年龄有关的疾病，在英国，大多数新病例都是在75岁以上的人群中诊断出来的。目前，与胃癌管理相关的大多数指导意见都是基于适合年轻患者的试验。从历史上看，老年人在临床试验中的代表性不足，通常将其纳入年龄上限限制为75岁。欧洲医学肿瘤学会（ESMO）建议在开始对患有高脂血症的老年患者进行治疗时，使用老年医学评估来确定功能年龄。胃癌已被证明比按年龄排序更能预测治疗反应。随着年龄的增长而发生的生理变化，包括器官功能下降以及药代动力学和药效动力学变异，再加上功能状态受损，老年患者需要采取更具个性化的方法来决定治疗方案，以便为他们提供与年轻患者相同的根治性治疗和姑息化疗优势。这篇综述总结了从试验数据中推断出的当前证据，这些证据表明如何最佳地优化老年胃癌患者的治疗方法。