Analysis of docetaxel therapy in elderly (⩾70 years) castration resistant prostate cancer patients enrolled in the Netherlands Prostate Study

Abstract

BackgroundProstate cancer truly is an age-associated disease. Due to the increased life expectancy and more sensitive diagnostic techniques in the Western world, prostate cancer is diagnosed more frequently and with rapidly increasing incidence and prevalence rates. However, age above 65 or 70years has been an exclusion criterion in clinical trials for decades and the knowledge about chemotherapy tolerance in elderly is limited. MethodsWe 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 in elderly men (>70years) with castration resistant prostate cancer (CRPC) and bone metastases. Statistical analyses were performed stratified for age into four categories: <70 (n=315), 70–74 (n=150), 75–79 (n=85), and ⩾80years old (n=18). ResultsWe analysed 568 patients (median age 68.1years, range 46–89years, 44.5% aged ⩾70years). There was no relation between dosage and age (p=0.60). We found no significant differences between the number of dose reductions, time to progression (TTP), overall survival, chemotherapy tolerance and toxicity up to the age of 80years. However, when compared to younger men, men aged 80years or above more frequently experienced grade 3/4 toxicity and were five times less likely to complete the first three treatment cycles at the intended dose (Odds ratio (OR) 5.34, p=0.0052) and showed decreased overall survival (15.3months versus 24.5months in <80years group, p=0.020). ConclusionIn CRPC patients up to the age of 80years, docetaxel chemotherapy is well tolerated, with toxicity levels and TTP comparable to those of younger patients. For chemotherapeutic treatment of patients above the age of 80years an individual assessment should be made.