Population-based study on use of chemotherapy in men with castration resistant prostate cancer

Abstract

Background. Chemotherapy prolongs life and relieves symptoms in men with castration resistant prostate cancer (CRPC). There is limited information on a population level on the use of chemotherapy for CRPC.Material and methods.To assess the use of chemotherapy in men with CRPC we conducted a register-based nationwide population-based study in Prostate Cancer data Base Sweden (PCBaSe) and a nationwide in-patient drug register (SALT database) between May 2009 and December 2010. We assumed that men who died of prostate cancer (PCa) underwent a period of CRPC before they died. Results.Among the 2677 men who died from PCa during the study inclusion period, 556 (21%) had received chemotherapy (intravenous or per oral) detectable within the observation period in SALT database. Specifically, 239 (61%) of men < 70 years had received chemotherapy, 246 (30%) of men between 70 and 79 years and 71 (5%) men older than 80 years. The majority of men 465/556 (84%) had received a docetaxel-containing regimen. Among chemotherapy treated men, 283/556 (51%) received their last dose of chemotherapy during the last six months prior to death. Treatment with chemotherapy was more common among men with little comorbidity and high educational level, as well as in men who had received curatively intended primary treatment.Conclusion.A majority of men younger than 70 years with CRPC were treated with chemotherapy in contrast to men between 70 and 79 years of whom half as many received chemotherapy. Chemotherapy treatment was often administered shortly prior to death. The low uptake of chemotherapy in older men with CRPC may be caused by concerns about tolerability of treatment, as well as treatment decisions based on chronological age rather than global health status.

Treatment Patterns and Trends in Patients Dying of Prostate Cancer in Quebec: A Population-Based Study

“…Use of chemotherapy showed an upward trend after 2005, with a peak in 2009, which could be explained by a slow uptake of docetaxel. On average, chemotherapy use remained low in our cohort, with an overall penetrance of less than 25%, similar to usage rates reported in other observational studies 24,25,42 . The high proportion of patients more than 75 years of age in our population could partly explain the low rate of chemotherapy use overall.…”

“…Despite the fact that aging is known to increase the risk of comorbidities that could influence a patient's performance status, chronologic age seems to have played a role in decision-making and therapy selection in our cohort, more so than the presence of comorbidities. Likewise, Lissbrant et al 25 recently reported that, compared with their younger counterparts, elderly patients were less likely to receive chemotherapy when reaching crpc. Another study revealed a chemotherapy rate of 45.4% in patients with bone metastasis secondary to pca during the 2003-2011 period in the United States 45 .…”

“…Chemotherapy with docetaxel in the first line for mcrpc has remained the only therapeutic alternative to offer a survival benefit for mcrpc since shortly after the year 2000. Still, use of docetaxel is limited to a small percentage of mcrpc patients 17,23,24 -mostly those who are younger 25,26 -and is generally reserved for those with symptomatic mcrpc 27 . Additionally, because of the high frequency of bone metastasis, the management of mcrpc often requires the use of palliative radiotherapy (rt) and bone-targeted therapies to reduce the disease burden and bone-related morbidity [28][29][30][31] .…”

Enzalutamide in Metastatic Prostate Cancer before Chemotherapy

“…22–24 Thus, there is a need for effective, convenient, and less toxic therapies. Sipuleucel-T showed an overall survival advantage in asymptomatic or mildly symptomatic men, most of whom had not received chemotherapy, but did not induce tumor responses or delay disease progression or deterioration in quality of life.…”

Enzalutamide in Metastatic Prostate Cancer before Chemotherapy

“…[22][23][24] Thus, there is a need for effective, convenient, and less toxic therapies. Sipuleucel-T showed an overall survival advantage in asymptomatic or mildly symptomatic men, most of whom had not received chemotherapy, but did not induce tumor responses or delay disease progression or deterioration in quality of life.…”