Hepato-bilio-pancreatic Cancers in Older Adults: Challenges and Emerging Treatment Strategies

Hepato-bilio-pancreatic (HBP) cancers, including hepatocellular carcinoma, biliary tract cancers, and pancreatic cancer, represent a heterogeneous group of malignancies associated with a high burden of morbidity and mortality. Their incidence increases with age, making the management of older adults a relevant challenge in daily oncology practice. Despite this growing burden, older patients remain underrepresented in clinical trials, and evidence guiding treatment decisions in this population is still limited.The management of older adults with HBP cancers is particularly complex because chronological age alone does not adequately reflect physiological reserve or treatment tolerance. Frailty, comorbidities, polypharmacy, nutritional impairment, cognitive and functional status, and social vulnerability may influence treatment feasibility and clinical outcomes. Older patients are often at risk of inappropriate assessment, potentially resulting in over- or undertreatment, unnecessary toxicities, or avoidable risks. Comprehensive geriatric assessment and other multidimensional approaches may therefore support a more individualized evaluation and help identify potentially reversible vulnerabilities.It is therefore of major importance to appropriately integrate emerging systemic treatments, including targeted therapies, immunotherapy, and combination strategies, into the management of older patients, while identifying the most appropriate therapeutic strategy for each individual patient.The main goals of this Research Topic are:• To explore treatment strategies specifically tailored to older patients, considering the evolving role of systemic therapies, targeted therapies, immunotherapy, combination strategies, surgery, and locoregional treatments.• To investigate clinical and geriatric factors that may influence treatment feasibility and outcomes, including frailty, comorbidities, polypharmacy, drug–drug interactions, nutritional status, and other potential risk factors for toxicity or treatment discontinuation.• To evaluate the role of geriatric assessment and multidimensional approaches in treatment selection, risk stratification, identification of potentially reversible vulnerabilities, and optimization of outcomes in older patients with HBP malignancies.• To highlight the evidence already available for older patients with HBP cancers, including data from dedicated studies, subgroup analyses of clinical trials, and real-world studies, giving greater visibility to a population that remains underrepresented in prospective research.We welcome Original Research, Reviews, Systematic Reviews, Clinical Trials, and other relevant contributions addressing:● Clinical evidence in older patients with HBP cancers, including dedicated studies, subgroup analyses from clinical trials, and real-world evidence.● Systemic treatment strategies for older patients, including chemotherapy, targeted therapies, immunotherapy, and combination approaches, with particular attention to efficacy, tolerability, and treatment optimization.● Surgical and locoregional treatment approaches in older adults, including patient selection, perioperative management, treatment feasibility, and clinical outcomes.● Frailty, comorbidities, polypharmacy, and drug–drug interactions, including their assessment through validated screening tools, questionnaires, scales, and prognostic or risk indices, and their potential impact on treatment selection, toxicity, treatment adherence, and oncological outcomes.● Geriatric assessment and multidimensional approaches, including nutritional, functional, cognitive, and social assessment, as tools for risk stratification, treatment personalization, and supportive care in older patients with HBP malignancies.Please note: Manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent clinical or patient cohort, or biological validation in vitro or in vivo, which are not based on public databases) are not suitable for publication in this journal. Topic editors: Elena Orlandi, Prof Amit Gupta, Takashi Kokudo Source: https://www.frontiersin.org/research-topics/85856/hepato-bilio-pancreatic-cancers-in-older-adults-challenges-and-emerging-treatment-strategies