Reconsidering chemotherapy for older men with advanced prostate cancer

This study investigated the effects of health status in older patients with metastatic castration-resistant prostate cancer on treatment outcome with taxane-based chemotherapies. Researchers reported that taxane-based chemotherapies were associated with a significant survival benefit, regardless of age and health status.

Chemotherapy with taxane-based agents, such as docetaxel (Taxotere) is often required to treat metastatic castration-resistant prostate cancer (cancer that has spread despite hormonal therapy).

However, older men are often denied taxane therapy due to concerns of complications and lower life expectancies associated with older age and additional medical conditions. In order for survival-extending treatments such as taxane chemotherapy to be made available for older men, further studies are needed to determine the effects of patient health and age on treatment outcome.

This study analyzed data from 333 men aged 70 years or older receiving treatment for metastatic castration-resistant prostate cancer. Men were divided according to taxane therapy received, or no taxane therapy received. Men were classified as fit, vulnerable, or frail according to additional medical conditions and overall heath status. Treatment outcomes were followed-up for six months. 49 men deceased over the course of the study. Of these, 37 (76%) men deceased due to prostate cancer and 12 (24%) men deceased due to other causes.

Men not receiving taxane therapy were 47% less likely to survive during the study follow-up, when compared to men receiving taxane therapy. Six-month survival was 91% for older patients receiving taxane therapy and 81% for men not receiving taxane therapy. Even after accounting for for multiple factors (such as age and cancer stage), taxane therapy was associated with a significant survival benefit over non-taxane therapy.

Even among older men classified as frail (according to additional medical conditions and overall heath status), survival was significantly increased if taxane therapy was received (86% overall survival at 6-months compared to 58% if no taxane was received). Among frail older men, a modified regimen (reduced dosage) was used in most cases.

Taxane therapy slowed disease progression significantly more than non-taxane therapy among men classified as either fit or vulnerable, although no survival benefit was shown at 6-months. Age was not found to affect treatment outcome.

Taxane therapy was generally well-tolerated. However, side-effects such as fatigue, nausea and vomiting, and neutropenia (low white blood-cell count) were more common with taxane therapy (reported in 10 to 17% of men). Older men classified as frail were more likely to report side-effects than men classified as either fit or vulnerable.

Researchers concluded that taxane-based chemotherapy is a safe and effective treatment option for older men with metastatic castration-resistant prostate cancer, regardless of health status.

Larger treatment allocation and patient stratification randomized trials are needed to confirm these results.