Is cancer biology different in older patients?

Roughly 50% of cancer cases occur in people aged 65 years or older. Older people are often diagnosed at a later stage and might receive less (intensive) treatment, which might affect the outcome. In addition, an older age might be associated with biological differences in tumour and microenvironment behaviour, a domain that has been poorly studied so far. In this narrative Review of published literature, we explored the reported differences in tumour biology according to age in five major cancer types: breast, colorectal, prostate, lung, and melanoma. Our literature search uncovered clear differences in tumour histology and subtype distribution in older people compared with younger patients, as well as age-specific patterns of tumour mutations and other molecular alterations. Several studies also indicate notable changes in tumour-infiltrating immune cells in tumours of older versus younger people, although this research is still in its infancy. More research is needed and might lead to a better understanding of the biology of ageing in relation to malignancy. This knowledge could provide new perspectives for more personalised cancer treatments, eventually improving the global outcomes of older patients with cancer.

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Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests HW's institution (Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium) received financial compensation for advisory board and lecture fees from AbbVie, ARIEZ, AstraZeneca, AstraZeneca Ireland, Biocartes, Congress Care, Daiichi Sankyo, Eisai, Immutep, Federaal Kenniscentrum Voor de Gezondheidszorg, Lilly, Merck Sharp & Dohme, Novartis, ORION Corporation, Pfizer, PSI CRO AG, Puma Biotech, Roche, Sirtex, The Planning Shop, and Aptitude Health; and an unrestricted research grant from Roche. LD's institution received research grants from Boehringer Ingelheim; financial compensation for advisory board and lecture fees from AstraZeneca, Bristol Myers Squibb, Merck Sharp & Dohme, and Roche; and travel support from AstraZeneca, Merck Sharp & Dohme, and Roche. FB received financial compensation for advisory boards and lecture fees from Bayer, Bristol Myers Squibb, GlaxoSmithKline, Merck, and Merck Sharp & Dohme; a research grant from Sanofi; and travel support from Bristol Myers Squibb, GlaxoSmithKline, and Merck Sharp & Dohme. All other authors declare no competing interests.