Klin Onkol 2025; 38(5): 368-376. DOI: 10.48095/ccko2025368.
Background: Chemotherapy is a key therapeutic modality in the treatment of malignant diseases. While it represents an effective tool in managing these conditions, it is simultaneously a toxic treatment associated with numerous adverse effects, particularly in fragile patients, such as the elderly. Adverse effects of cytotoxic therapy are among the key factors contributing to the poor prognosis of older cancer patients, often resulting in treatment delays, dose reductions, or even premature termination of therapy. The increased susceptibility of geriatric patients to the toxic effects of chemotherapy arises from their unique characteristics. Alterations in the pharmacokinetics of anticancer drugs in elderly patients represent one of the main mechanisms of chemotherapy toxicity in this patient population. The presence of comorbidities further elevates the risk of adverse effects and diminishes the body‘s tolerance to treatment. As a consequence, there may be an increased vulnerability to organ-specific toxicity of cytotoxic agents. Due to the presence of multiple comorbidities, older patients are often exposed to polypharmacy, which represents an additional risk factor for chemotoxicity due to the increased likelihood of drug interactions at both the pharmacodynamic and pharmacokinetic levels. Identifying at-risk patients through the application of comprehensive geriatric assessment and scoring tools provides an approach to evaluating chemotherapy-related risks, thereby supporting the personalization of treatment and the reduction of toxicity. Aim: The article provides an analysis of the various mechanisms of chemotherapy toxicity in elderly patients, the factors contributing to their vulnerability, as well as the possibilities for safely administering cytotoxic agents while preserving their therapeutic efficacy in this patient population.