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Introduction: Oral targeted therapies (OTTs) are widely used for cancer management. However, there is no consensus on OTT dose adaptation in older patients with cancer. Methods: This noninterventional, retrospective study was a real‐life assessment of dose adaptation for six OTTs (afatinib, everolimus, palbociclib, pazopanib, sorafenib and sunitinib), at baseline and during treatment, and the reasons for the changes, in ≥70‐year‐old patients treated between February 2016 and August 2019. Data were compared with univariate models fitted with all variables. Results: Among the 986 patients treated with OTT, the group of ≥70‐year‐old patients (n = 122) received afatinib (15.6%), everolimus (14.8%), palbociclib (50.8%), pazopanib (9.8%), sorafenib (5.8%) or sunitinib (3.2%). At baseline, the prescribed OTT dose was adapted (reduction) in 29% of ≥70‐year‐old patients (35/122). These 35 patients were significantly older (mean age 80 vs 74 years, P <.001), and more frequently had a performance status score ≥2 (P <.01) than the other patients (n = 87). In the standard dose group, higher toxicity grades (P =.18) and subsequent dose reduction (41% of patients, 36/87) tended to be more frequent compared with the baseline adapted dose group (26%, 9/35, P =.1). At the study end, 53% of patients in the whole cohort (65/122) were taking a lower dose than the recommended one. Conclusion: At OTT initiation, dose was adapted in 29% of older adults with cancer, rarely after a formal oncogeriatric evaluation (6.5% of all patients). In the absence of recommendations, clinical studies are needed to evaluate the efficacy and safety of baseline OTT dose reduction in older adults with cancer. [ABSTRACT FROM AUTHOR]