Over-70s with gastric cancer did as well as younger patients on perioperative therapy

Design

Exploratory age-subgroup analysis of a phase 3 randomised trial

Population

574 patients with resectable gastric cancer; 135 aged 70 or over

Primary outcome

Treatment adherence, toxicity and survival by age

Effect

Overall survival HR 0.86 (0.58-1.26) and 0.75 (0.51-1.11), older vs younger

An exploratory analysis of the phase 3 TOPGEAR trial (European Journal of Cancer, 22 August 2026) compared 135 patients aged 70 or over with 439 younger patients, all with resectable gastric or junctional adenocarcinoma and good performance status (ECOG 0-1), randomised to perioperative chemotherapy with or without preoperative chemoradiotherapy.

Older patients more often needed preoperative dose reductions, omissions or delays (55% vs 35% in the chemoradiotherapy arm). Overall grade 3 or worse toxicity was similar, but older patients had more haematological toxicity (56% vs 37%) and severe diarrhoea (21% vs 6%) with chemotherapy. Resection rates, surgical complications and 30- and 90-day mortality were similar, and overall survival was at least as good (HR 0.86 and 0.75 by arm, intervals crossing 1).

This is evidence against chronological age as a reason to withhold curative-intent treatment. The patients were trial-selected and fit, so the lesson is to assess fitness - with a geriatric assessment - rather than to treat every over-70 the same. Expect to modify doses and support patients through toxicity.

• Do not exclude fit older adults from curative gastric cancer treatment on age alone
• Use a geriatric assessment to judge fitness for perioperative therapy
• Plan early for dose adjustments and close toxicity monitoring
• Watch closely for diarrhoea, dehydration and neutropenia in older patients

Why it matters

It challenges age-based decisions to offer less than curative treatment.

Don't overread it

Trial-selected fit patients in an exploratory subgroup - not evidence for frail older adults.

The statistics, in plain English

Survival hazard ratios below 1 favour older patients numerically, but the intervals cross 1, so outcomes are best read as similar. This is a subgroup analysis of trial participants, who are fitter than the average older patient.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.