Chemotherapy for Prostate Cancer in Senior Adults: Are We Treating the Elderly or the Frail?

Abstract

Chemotherapy was considered ineffective in hormone-refractory prostate cancer (HRPC) until a paradigm shift was established in 2004. Two randomised phase 3 trials were published (the TAX327 trial and the Southwest Oncology Group [SWOG] trial) [1,2] showing a statistically significant survival benefit with docetaxel in combination with estramustine1 or prednisone [2] when compared to the standard mitoxantrone prednisone (MP). Since then, docetaxel chemotherapy has become the standard first-line treatment for HRPC. However, because patients randomised in phase 3 clinical trials are highly selected, they may not represent a real-life population. Consequently, the benefit observed in both trials is only applicable to patients fulfilling specific eligibility criteria. An updated survival analysis, including data on 310 additional deaths [3], was reported in January 2008. The analysis showed that the survival benefit of docetaxel every 3 wk persisted with extended follow-up ( p = 0.004). In addition, subsequent data provided showed that docetaxel every 3 wk improved survival in men both older and younger than 68 yr of age. Even if the trial was not initially designed to address subgroup analysis, this and other retrospective data analysis provide some helpful information on benefit based on patients’ age and guides when to start chemotherapy. Whether there is an age limit for patients to receive chemotherapy is consequently a highly relevant question, specially taking into account that