Chemotherapy (chemo with docetaxel) has a reputation for being a difficult therapy loaded with many side effects. I believe that this reputation is overblown given that all of our new non-chemotherapies (other than Provenge) come with their own list of significant side effects. However, its reputation is in the minds of many, so men who are elderly will often choose to forgo chemo because of the age and comorbidities as well as an underlying cynicism around the possible survival advantages at this older age.
Is this the right decision? Should older men 80 years and older have chemotherapy to treat their advanced prostate cancer?
A group of Italian researchers performed a retrospective study aimed to assess the clinical outcomes in this very elderly castrate resistant advanced prostate cancer (CRPC) population.
They reviewed a consecutive series of 115 men from 28 Italian hospitals with a median age was 82 (range 80 to 90) and a median baseline prostate-specific antigen (PSA) of 92 ng/ml (range 3 to 2,981); 83% of the men had bone metastases, while nodal, lung and liver metastases were observed in 39%, 9%, and 8% of the men respectively.
They found a PSA reduction greater than 50% in 55% of the men; an objective response was observed in 15% of the 60 men who underwent a radiological re-evaluation at the treatment end.
Grade 3-4 toxicities were: anemia (2%), neutropenia (10%) , thrombocytopenia (2%), fatigue (10%), diarrhea (4%), nausea (2%), renal (2%), and febrile neutropenia (2%). The median progression-free survival (PFS) and overall survival (OS )were 7 months and 20 months, while the 1 year PFS and OS rates were 21.2% and 71.5%, respectively.
This data suggests that a population of selected very older (age 80 and older) advanced prostate cancer survivors can safely have chemotherapy with a good toxicity profile. In this older population chemotherapy is able to produce survival outcomes comparable to pivotal trials (18
J Clin Oncol 32, 2014 (suppl 4; abstr 92); Antonello Veccia, Salvatore Luca Burgio, Giuseppe di Lorenzo, Cinzia Ortega, Florinda Scognamiglio, Michele Aieta, Fable Zustovich, Rodolfo Mattioli, Giovanni Mansueto, Gaetano Facchini, Giuseppe Procopio, Alessandro D’Angelo, Gilbert Spizzo, Maddalena Donini, Roberto Bortolus, Giovanni Vicario, Paolo A. Zucali, Umberto Basso, Giovanni Lo Re, Orazio Caffo, DELPHY Study Group
Joel T. Nowak, M.A., M.S.W.