NIV Congres

Introduction: Prostate cancer truly is an age-associated disease, approximately half of prostate cancer patients in the Netherlands are aged 70 years or older at the time of diagnosis. Due to the increased life expectancy and more sensitive diagnostic techniques in the western world, prostate cancer, like most other malignancies, is diagnosed more frequently and with rapidly increasing incidence and prevalence rates. However, age above 70 years has been an exclusion criterion in many clinical trials. Hence the knowledge about chemotherapy tolerance and toxicity in patients aged 70 years and above is limited. This possibly results in mistreatment of cancer patients of advanced age.

Aim of the study: To evaluate the influence of age on docetaxel chemotherapy in elderly (≥ 70 yrs) castration resistant prostate cancer (CRPC) patients.

Material and Methods: We performed a retrospective analysis of data acquired from the recently published Netherlands Prostate Study (NePro) to evaluate the influence of advanced age on docetaxel therapy (75 mg/m²) in men with CRPC and bone metastases (mCRPC). For statistical analyses the data was stratified into four categories: < 70, 70-74, 75-79, and ≥ 80 years of age. Docetaxel tolerance was quantified by assessment of completion of the first three cycles at the intended dose. Common Terminology Criteria for Adverse Events (CTCAE) version 2.0 was used to grade toxicity. Time to progression (TTP) was assessed as previously described.

Results: We analyzed 568 patients (median age 68.1 yrs, range 46-89 yrs, 44.5% aged ≥ 70 yrs). There was no relation between dosage and age (p = 0.60). We found no significant differences between the number of dose reductions, TTP, overall survival, chemotherapy tolerance and toxicity up to the age of 80 years. However, when compared to younger men, men aged 80 years or above more frequently experienced grade 3/4 toxicity, were five times less likely to complete the first three treatment cycles at the intended dose (OR 5.34, p = 0.0052) and showed decreased overall survival (15.3 mos versus 24.5 mos in < 80 yrs group, p = 0.020).

Conclusion: In mCRPC, and possibly other cancer patients, up to the age of 80 years docetaxel chemotherapy is well tolerated with toxicity levels, tolerance and TTP comparable to that of younger patients. However, for chemotherapeutic treatment of patients aged 80 years and above an individual assessment should be made.