When we hear the term “targeted therapy,” we often think of oncogene inhibitors and next-generation sequencing aimed at uncovering rare genomic alterations in individual cancers. While targeting constitutively active pathways like FGFR and KRAS has undoubtedly advanced the field, oncology continues to fall short in addressing one of the most common and impactful patient factors: aging.

As our population ages, the majority of patients receiving cancer treatment are older adults. Yet, the stringent eligibility criteria of clinical trials often exclude this population, resulting in study cohorts that are years—sometimes decades—younger and healthier than the real-world patients we aim to treat. Consequently, we apply "standard-of-care" data to older adults without knowing whether these are the right drugs, at the right doses, or on the right schedules for individuals with unique geriatric comorbidities and vulnerabilities.

Moreover, the goals of care for older patients often differ from those of younger adults. Many prioritize quality of life, independence, and functional preservation over maximum longevity. Our treatments and supportive care should reflect and support these values.

Professional oncology societies universally recommend comprehensive geriatric assessment (CGA) as a critical tool to identify factors such as frailty, cognitive impairment, and polypharmacy that disproportionately affect older adults. Yet, CGA remains underutilized in routine practice, hindered by perceived barriers like time constraints and limited geriatrics training.

It is time to reframe aging in cancer not as an obstacle, but as a modifiable, targetable domain. Clinical trials and interventions must be designed with the aging patient in mind—treating not just the tumor, but the person. This issue highlights cutting-edge science and innovative strategies aimed at personalizing cancer care for older adults and advancing equitable, evidence-based treatment for this growing patient population.

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.

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Personalized Oncologic Care for Older Adults