# Test cancer drugs in old and unhealthy animals, not just young fit ones

Source: https://onco.cc/ideas/idea-bio1-aged-comorbid-models/  
OnCo record `idea-bio1-aged-comorbid-models` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Most cancer patients are older and have other illnesses, but nearly all animal experiments use young healthy mice. Results may not transfer.

## Summary

Ageing changes immune function, drug metabolism, marrow reserve and the tumour microenvironment; obesity and diabetes alter drug distribution and immunotherapy response. Efficacy and toxicity studies in aged, obese or comorbid animals cost more and take longer, so they are rarely done. Requiring at least one aged-cohort confirmation before first-in-human studies of immunotherapies would be a targeted change.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: For a meaningful minority of agents, efficacy or toxicity in aged or obese animals differs materially from young lean animals in a direction that predicts clinical experience in older patients.
- Rationale: Age-related immune decline is documented in mice and humans, and obesity paradoxically improves some immunotherapy outcomes; these interactions are invisible in the standard young mouse.
- Proposed test: Repeat pivotal efficacy studies for ten agents with known clinical outcomes in aged and diet-induced obese cohorts and compare which model better matches the clinical result.
- Maturity: preclinical-evidence
- Actor: research

## Sources

- Bottleneck evidence (Lab models that fail to predict what happens in patients): Wong, Siah & Lo, Estimation of clinical trial success rates (Biostatistics 2019): https://doi.org/10.1093/biostatistics/kxx069

## Connected records

- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- terms: [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/)
- bottlenecks: [Lab models that fail to predict what happens in patients](https://onco.cc/bottlenecks/b-preclinical-models/), [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/)
- key papers: [Estimation of clinical trial success rates and related parameters](https://onco.cc/key-papers/paper-wong-biostatistics/)

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