The number of older adults being treated for cancer is increasing. Despite this, older patients are under-represented in clinical trials. Those who are included are unlikely to be an accurate reflection of real-world patients as many are excluded based on performance status and comorbidities. There is a paucity of data examining the toxicity, and effectiveness, of systemic therapy in this group; particularly in a regional Australian cohort. Retrospective data from patients ≥75 years, on treatment for a solid organ malignancy in an Australian regional center was collected to assess the toxicity, and effectiveness, of immunotherapy and chemotherapy. Ninety-two patients were included. The mean age was 81. There was no significant difference in overall survival based on; age, Eastern Cooperative Oncology Group score, or number of comorbidities. Only 27% of treatments were ceased due to toxicity. 35% of patients on chemotherapy had had a dose reduction during treatment. Grade ≥3 toxicity was experienced by 32% of patients who received chemotherapy-containing regimens and 22% who received immunotherapy-containing regimens. To our knowledge, this is the first study providing real-world data on the effectiveness, and safety, of anti-cancer agents in older patients in a regional Australian center across multiple tumor streams. In older adults otherwise well enough for treatment, outcomes from treatment were not greatly affected by age. Other factors, rather than age and comorbidities alone, may predict outcomes. The use of screening tools may help select patients for comprehensive geriatric assessment.