First-line treatment in senior adults with metastatic castration-resistant prostate cancer: A prospective international registry

被引:14
作者
Droz, Jean-Pierre [1 ]
Efstathiou, Eleni [2 ]
Yildirim, Asif [3 ]
Cabrera, Paula [4 ]
Kim, Choung Soo [5 ]
Horchani, Ali [6 ]
Heidenreich, Axel [7 ]
Rinck-Junior, Jose Augusto [8 ]
Hitier, Simon [9 ]
Ozen, Haluk [10 ]
机构
[1] Univ Lyon 1, Leon Berard Canc Ctr, Dept Canc, Environm Res Unit, F-69365 Lyon, France
[2] Univ Athens, Dept Med Oncol, Athens, Greece
[3] SB Goztepe Training & Res Hosp, Dept Urol, Istanbul, Turkey
[4] Inst Nacl Cancerol, Dept Urol, Mexico City, DF, Mexico
[5] Asan Med Ctr, Dept Urol, Seoul, South Korea
[6] La Rabta Hosp, Fac Med, Dept Urol, Tunis, Tunisia
[7] Univ Klinikum Aachen, Dept Urol, Aachen, Germany
[8] Hosp Canc AC Camargo, Dept Urol, Sao Paulo, Brazil
[9] Sanofi Oncol, Paris, France
[10] Hacettepe Univ, Dept Urol, Ankara, Turkey
关键词
Comorbidity; Docetaxel; Geriatric assessment; Taxoids; MITOXANTRONE PLUS PREDNISONE; DOCETAXEL; CHEMOTHERAPY; AGE; GUIDELINES; OLDER; MANAGEMENT; SURVIVAL; MEN;
D O I
10.1016/j.urolonc.2015.12.005
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Aims: To compare the efficacy and tolerability of taxane and nontaxane therapy in senior adults with chemonaive metastatic castration resistant prostate cancer (mCRPC), and examine the effect of patient health status on outcomes. Patients and methods: Between 2009 and 2011, 333 patients aged >= 70 years with mCRPC were enrolled in a prospective international registry. Patients were categorized as having received taxane-based or nontaxane therapy, and classified as fit, vulnerable, frail, or terminal, according to investigator judgement or International Society of Geriatric Oncology guidelines. Efficacy measures included overall survival (OS) and progression-free survival. Grade 3/4 toxicities were recorded. Predictors of OS were identified using multivariate Cox regression. Results: The proportions of fit/vulnerable/frail patients were 65%/14%/17% (International Society of Geriatric Oncology), and 39%/43%/ 17% (investigator). In single-factor analyses, taxane therapy improved OS (hazard ratio [95%CI] = 0.53 [0.30-0.93]; P = 0.027) and progression-free survival (hazard ratio [95% CI] = 0.55 [0.40-0.76]; P < 0.001) vs. nontaxane therapy. Patients with frailty also benefited from taxane therapy (adapted regimen in 52%). In multivariate analysis, taxanes improved OS even with poor prognostic factors present (P = 0.017); age was unrelated to prognosis. Taxane therapy was well tolerated; most common grade 3/4 toxicities (taxane vs. nontaxane) were fatigue (17% vs. 4%), nausea/vomiting (14% vs. 5%) and neutropenia (10% vs. 1%). Conclusions: The results of this nonrandomized, observational study suggest that first-line taxane therapy may benefit senior adults with mCRPC more than alternative therapies. Treatment decisions should not be based on chronological age. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:234.e21 / 234.e29
页数:9
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