Introduction

In oncology clinical trials, elderly are often under-represented and this status quo still persists despite a clear need for efficacy data in this age category.1 This is due to several reasons: first, the survival age in the general population is increasing and so is the pool of subjects belonging to the older age. Second, many prevalent malignancies such as lung cancer are most often cancers of the elderly. Last but not least, the efficacy data for oncological therapies in the elderly might help a lot in better tailoring their management approach.

Among the causes related to the clinical study design, often exclusion criteria are represented by the presence of various comorbid chronic conditions and by poor performance (functional) status that are both attributes of ageing. However, can physical frailty be a major reason for avoiding cancer drugs in elderly? This perspective tries to make the case for the use of immune therapy in elderly with impaired functional status based on the available (even if limited) evidence and based on the premise that in such patients this approach can still have the potential to improve the quality of life as a palliative care approach.