Chemotherapy in frail elderly patients with hormone-refractory prostate cancer: A “real world” experience

Abstract

BackgroundIn elderly patients affected by metastatic castration-resistant prostate cancer (mCRPC) chemotherapic treatment may be the choice if one considers not only the chronological age, but also the clinical status, the functional reserve, and the vulnerability of patients. Several studies have confirmed the survival benefit of docetaxel and vinorelbine among every class of age. Most CRP elderly patients are defined as frail, maybe due to comorbidities: these patients, who are unable to be candidates for a standard treatment, should be candidates for a more tolerable treatment.MethodsTwenty-six elderly, frail patients were evaluated. The patients were affected by mCRPC and were receiving chemotherapy with intravenous weekly docetaxel (12 patients) or oral metronomic vinorelbine (14 patients). Safety and efficacy were investigated evaluating clinical and objective response and tolerability. The level of patient satisfaction with treatment was assessed through a questionnaire.ResultsNo significant difference was found between groups in terms of 6-month progression-free survival: 57.1% for patients treated with oral metronomic vinorelbine versus 58.3% for patients treated with docetaxel. Median progression free survival was 8.6 months (95% confidence interval: 7.1–9.4 months), and 8.2 months (95% confidence interval: 6.9–9.3 months) for patients treated with oral metronomic vinorelbine and socetaxel, respectively. Oral metronomic vinorelbine was associated with increased patient satisfaction with respect to docetaxel administration. The most frequent side effect associated with oral metronomic vinorelbine was anemia and vomiting, with similar frequency compared to patients treated with docetaxel.ConclusionWeekly docetaxel and oral metronomic vinorelbine are equally effective and well tolerated in elderly unfit and frail patients affected by mCRPC. Metronomic vinorelbine treatment is associated with higher patient compliance and satisfaction.

Metronomic Chemotherapy for Advanced Prostate Cancer: A Literature Review

“…Eleven studies (37%) were retrospective analyses. Among the nineteen prospective studies, two (11%) were phase I [ 27 , 36 ], one (5%) was phase I/II [ 47 ], and sixteen (84%) were phase II studies [ 22 , 25 , 26 , 29 , 30 , 33 , 34 , 37 , 38 , 40 , 41 , 42 , 43 , 45 , 48 , 49 ]. Across both prospective and retrospective phase II type studies, the majority (23/26, 88%) were single arm trials [ 19 , 21 , 22 , 23 , 25 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 37 , 38 , 40 , 41 , 42 , 44 , 48 , 49 ].…”

Metronomic Chemotherapy: A Systematic Review of the Literature and Clinical Experience

“…Vinorelbine alone was compared to weekly docetaxel in frail CRPC patients for efficacy, tolerability, toxicity, and compliance. Efficacy and tolerability of the two regimens were found to be similar in elderly unfit patients [127]. In another phase I/II trial, CP 50 mg daily with lenalidomide 25 mg daily in first 21 days repeating every four weeks was tried in 6 patients with PSA reduction in 31.7%, with improved markers of neovascularization [128].…”

Which Way to Choose for the Treatment of Metastatic Prostate Cancer: A Case Report and Literature Review

“…In addition, cabazitaxel 20 mg/m 2 was deemed to be as effective as 25 mg/m 2 , while less toxicity was observed, which suggested a lower dose should be preferred to reduce adverse events ( 66 , 67 ). In frail elderly patients, metronomic chemotherapy, which is based on more frequent and low-dose drug administrations, such as daily oral vinorelbine and cyclophosphamide, provides an interesting alternative ( 68 , 69 ), yet much larger, controlled, and prospective clinical trials are needed to figure out the optimal regimens ( 70 ). In patients with DNA-damage repair mutations in genes such as BRCA1, BRCA2, and ATM, Olaparib, a PARP inhibitor, led to a high response rate ( 71 , 72 ), considering the potential similar mechanisms between olaparib and platinum ( 73 ), platinum-based chemotherapy may also be sensitive to this population ( 71 ), genetic test may play a valuable guiding role.…”