How do we trade off benefits and harms of anticancer drugs for advanced cancer patients?

Background: The overall survival rate of advanced cancer patients has improved thanks to the development of modern medical treatments, particularly new and innovative chemotherapeutic agents such as targeted therapies and immune checkpoint inhibitors. Current Concepts: Chemotherapy is administered in neoadjuvant, adjuvant, and palliative settings, and its ultimate goal is to improve overall survival. Chemotherapy has several proven and valuable clinical benefits, but also many side effects that cannot be ignored, especially in patients with poor European Cancer Oncology Group performance status. Therefore, we must carefully weigh and trade off the benefits and harms from many chemotherapy agents. In fact, it can be difficult to determine whether advanced cancer patients really benefit from chemotherapy, which is why a number of value measurement tools such as the American Society Clinical Oncology-Value Framework and the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale have been developed. Discussion and Conclusion: We need to include individual cancer patients in decision-making processes and use appropriate shared decision-making to decide whether or not to administer chemotherapy. Furthermore, we should perform rational trade-offs in consideration of limited health resources.