Geriatric Oncology Redefined: Toxicity Prediction and Treatment Tailoring in Frail and Elderly Breast Cancer

Geriatric oncology has emerged as a crucial field at the intersection of aging and cancer medicine, aiming to optimize cancer care for a growing population of very elderly and frail patients. In breast cancer, most advanced-stage patients in Europe are already over 65, making that threshold clinically uninformative; comprehensive geriatric assessment is instead routinely reserved for patients over 75, and frailty itself, independent of age, is increasingly recognized as the more decisive driver of treatment tolerance. Conventional systemic treatment protocols, including chemotherapy, endocrine therapy, antibody-drug conjugates (ADCs), and other targeted therapies, are largely developed and validated in younger, fitter cohorts and can cause disproportionate toxicity in very elderly or frail patients. Predicting systemic treatment toxicity in this specific population remains a major clinical challenge, and the limited integration of geriatric assessment tools and predictive biomarkers into routine practice continues to hinder safe, effective, and patient-centered treatment planning.This Research Topic focuses specifically on very elderly breast cancer patients (aged 75 and above) and on frail patients of any age, as defined by validated frailty or comprehensive geriatric assessment tools. It seeks research that identifies predictive factors for toxicity associated with chemotherapy, endocrine therapy, ADCs, and other targeted agents in these groups, explores the biological and functional basis of frailty in breast cancer, and assesses how geriatric evaluation tools, artificial intelligence, and machine learning can support treatment decisions. The goal is to foster multidisciplinary insights that inform frailty-adapted treatment algorithms and improve quality of life while preserving oncologic efficacy.To capture the breadth and depth of current research, we welcome articles including but not limited to the following topics:• Development and validation of prediction models for systemic treatment toxicity in patients ≥75/80 years or defined as frail• Comprehensive geriatric assessment and validated frailty tools in treatment planning and decision support• Clinical, biological, and pharmacokinetic predictors of treatment tolerance in very elderly or frail cohorts• Implementation and outcomes of frailty-adapted or de-escalated systemic treatment regimens• Tolerability, safety, and real-world use of ADCs and other targeted therapies in very elderly or frail patients• Patient-reported outcomes, quality-of-life metrics, and functional assessments in this populationWe encourage researchers to submit findings that help establish robust clinical pathways for this underrepresented population. Real-world studies, clinical trials, and reviews are highly welcomed to bridge geriatric science and oncology practice. We invite you to submit Original Research, Systematic Reviews, Mini Reviews, Clinical Trial articles, and Perspectives that help clinicians predict risk and optimize care for very elderly and frail breast cancer patients. Topic editors: Angioletta Lasagna, Vittorio Gebbia Source: https://www.frontiersin.org/research-topics/85458/geriatric-oncology-redefined-toxicity-prediction-and-treatment-tailoring-in-frail-and-elderly-breast-cancer