Older adults with gastric cancer achieve comparable survival despite higher toxicity and treatment modificationsOlder adults with gastric cancer show similar survival to younger patients

European journal of cancer (Oxford, England : 1990) Published October 10, 2026 Study authors: Rühle Alexander, Krause Alina, O'Connell Rachel L, Simes John, Michael Michael, Smithers Bernard Mar… PubMed ↗ DOI ↗ Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway

Note that older patients with gastric cancer achieve comparable survival despite higher rates of toxicity and treatment delays.

This secondary analysis of a Phase III trial evaluated 574 patients with resectable gastric or gastro-esophageal junction adenocarcinoma. The study compared outcomes between older adults (age 70 or more) and younger patients receiving perioperative chemotherapy (ECF/ECX or FLOT) or perioperative chemotherapy plus preoperative chemoradiotherapy (45 Gy in 25 fractions with concurrent fluoropyrimidine).

Main results showed that older adults experienced more frequent chemotherapy dose reductions, omissions, or delays (55% vs 35% in the chemoradiotherapy group; 60% vs 48% in the chemotherapy group). Older adults in the chemotherapy group also experienced significantly higher rates of hematologic toxicity (56% vs 37%, p = 0.006) and grade 3 or higher diarrhea (21% vs 6%, p < 0.001).

Despite these differences in treatment modifications and specific toxicities, survival outcomes were comparable between age groups. Overall survival (OS) showed HR 0.86 (95% CI 0.58-1.26) for the chemoradiotherapy group and HR 0.75 (95% CI 0.51-1.11) for the chemotherapy group. Progression-free survival (PFS) showed HR 0.78 (95% CI 0.53-1.15) and HR 0.70 (95% CI 0.47-1.03) respectively. Grade 3 or higher adverse events were comparable between age groups (66% vs 67% for chemoradiotherapy; 68% vs 59% for chemotherapy).

This study is an exploratory analysis. While older patients achieved comparable oncologic outcomes, they required more frequent treatment modifications and experienced higher rates of specific toxicities. Clinical interpretation should be cautious due to the exploratory nature of the data.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap regarding the management of older patients with gastric cancer. While previous evidence noted that trastuzumab and tislelizumab show lower HR-QoL deterioration in advanced gastric cancer, this study specifically addresses the impact of age on perioperative treatment tolerability and survival in resectable cases. It confirms that older patients can achieve comparable survival outcomes despite higher rates of treatment modifications and specific toxicities like diarrhea and hematologic toxicity.

When doctors treat older patients with gastric cancer, they often worry about how well the patient will tolerate intense chemotherapy. There is a common concern that older bodies might not handle the drugs as well as younger ones, potentially leading to different outcomes. However, a look at data from a large clinical trial offers a different perspective on what to expect.

Researchers looked at 574 patients with gastric cancer or esophageal junction adenocarcinoma. They compared older adults, aged 70 and over, to younger patients. The results showed that while older patients did experience more frequent issues like diarrhea and blood-related side effects, their overall survival and progression-free survival were comparable to those of younger patients.

It is important to note that this was a secondary analysis of a larger trial. While the survival numbers were similar, older patients did require more frequent dose reductions or delays in their chemotherapy. These findings suggest that while the treatment journey might involve more adjustments for older adults, the ultimate outcomes for their cancer remain similar to younger patients.

What this means for you:

Older adults with gastric cancer can achieve survival outcomes similar to younger patients despite more side effects.

Common questions

Are the survival rates similar for older and younger patients?

Yes, the study found that overall survival and progression-free survival were comparable between older adults (70 and over) and younger patients. While the numbers for older adults were slightly better in some cases, the difference was not statistically significant, meaning both groups performed similarly.

What kind of side effects did older patients experience?

Older adults in the chemotherapy group experienced more frequent cases of diarrhea (21% vs 6%) and more frequent hematologic toxicity (blood-related issues) compared to younger patients. However, the rate of severe grade 3 or higher adverse events was similar for both age groups.

Did older patients have to change their treatment plans more often?

Yes, older patients required more frequent chemotherapy dose reductions, omissions, or delays. This was especially noticeable in the chemoradiotherapy group, where 55% of older patients needed adjustments compared to 35% of younger patients.

Study Details

Study typeRct

Sample sizen = 574

EvidenceLevel 2

Follow-up840.0 mo

PublishedOct 2026

PMID42673704

View Original Abstract ↓

PURPOSE: To evaluate treatment adherence, adverse events, and survival in older (≥70 years) adults undergoing perioperative treatment for gastric cancer. METHODS: Patients with resectable gastric/gastro-esophageal junction adenocarcinoma (ECOG 0-1) enrolled in the phase III TOPGEAR trial were randomized to perioperative chemotherapy (ECF/ECX or FLOT) alone or perioperative chemotherapy plus preoperative chemoradiotherapy (45 Gy in 25 fractions with concurrent fluoropyrimidine). In this exploratory analysis, treatment completion, grade ≥ 3 adverse events (CTCAE v3.0), surgical outcomes, overall survival (OS) and progression-free survival (PFS) were compared between older and younger adults. RESULTS: Of the 574 patients enrolled, 135 (24%) were ≥ 70 years. Older adults more frequently required preoperative chemotherapy dose reductions, omissions, or delays (chemoradiotherapy: 55% vs 35%, p = 0.004; chemotherapy: 60% vs 48%, p = 0.087). Rates of grade ≥ 3 adverse events were comparable between older and younger patients (chemoradiotherapy: 66% vs 67%, p = 0.874; chemotherapy: 68% vs 59%, p = 0.220), but older adults more often had hematologic toxicity and grade ≥ 3 diarrhea in the chemotherapy group (56% vs 37%, p = 0.006; 21% vs 6%, p < 0.001). Resection rates, grade 3/4 surgical complications, number of removed lymph nodes, and 30-/90-day mortality were similar by age. OS and PFS were comparable across age groups, with numerically favorable outcomes for older adults (OS: HR 0.86, 95% CI 0.58-1.26 [chemoradiotherapy]; HR 0.75, 95% CI 0.51-1.11 [chemotherapy]; PFS: HR 0.78, 95% CI 0.53-1.15 [chemoradiotherapy]; HR 0.70, 95% CI 0.47-1.03 [chemotherapy]). CONCLUSIONS: Older adults with gastric cancer achieved comparable oncologic outcomes to younger patients, despite more frequent treatment modifications and higher hematologic toxicity.

Older adults with gastric cancer achieve comparable survival despite higher toxicity and treatment modificationsOlder adults with gastric cancer show similar survival to younger patients

How this fits prior evidence

Common questions

Study Details

First-line immune checkpoint inhibitor combinations improve overall survival in extensive-stage small-cell lung cancer

Immune checkpoint inhibitors combined with chemotherapy improve small cell lung cancer survival

Clinical research that matters. Delivered to your inbox.

Older adults with gastric cancer achieve comparable survival despite higher toxicity and treatment modificationsOlder adults with gastric cancer show similar survival to younger patients

How this fits prior evidence

Common questions

More on Gastric Cancer

Study Details

First-line immune checkpoint inhibitor combinations improve overall survival in extensive-stage small-cell lung cancer

Immune checkpoint inhibitors combined with chemotherapy improve small cell lung cancer survival

Clinical research that matters. Delivered to your inbox.

Related in Oncology

From Other Specialties