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

Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies)

“…Martinez and colleagues compared, in an observational study, apixaban, dabigatran, and rivaroxaban versus warfarin in frail older patients with nonvalvular atrial fibrillation, and concluded (in contradiction to findings in the previous section) that only rivaroxaban was associated with reduced risk of stroke or systemic embolism and there were no significant differences in the risk of major bleeding for NOACs when compared to warfarin [52]. In another study using frailty tools, Droz and colleagues evaluated the efficacy and tolerability of taxane therapy in senior adults with chemonaïve metastatic castration-resistant prostate cancer and found that frail patients experienced more toxicity events but still gained significant clinical benefit from taxane therapy [53]. In another study, antidepressant use in not frail older women was associated with increased risk of incident frailty after 3 years [54].…”

Current treatment strategies for advanced prostate cancer

“…An international collaborative study subsequently showed an advantage of using G8 score to assess tolerability for the treatment with taxanes, and concluded that treatment decision-making should be determined by individual health assessment, not by age. 101 Figure 1b shows the putative algorithm for the treatment of APC based on the provided findings. A result of a systematic review, which analyzed 13 retrospective studies of sequential therapy for patients after progression on docetaxel, showed that a sequence that includes cabazitaxel seems to confer an advantage for OS compared with successive use of ASIs, indicating that the standard option after docetaxel includes subsequent cabazitaxel for patients assigned to "fit or vulnerable" health status.…”

Consensus statements on the management of metastatic prostate cancer from the Hong Kong Urological Association and Hong Kong Society of Uro‐Oncology

“…A poorer performance status was found to be associated with lower treatment responses and reduced OS among patients with mCRPC . The toxicity profile of a treatment option is of particular concern in patients with a poor performance status; however, as clinical trials generally have excluded patients with a poorer performance status (Eastern Cooperative Oncology Group [ECOG] score of 3 or 4) , treatment options cannot merely be based on a performance status.…”

“…After reviewing a number of references , the panel concluded that neutrophil‐lymphocyte ratio, age, and presence of bone metastases are not meaningful factors in the physician's selection of an appropriate first‐line treatment option for patients with mCRPC.…”