Metronomic chemotherapy for metastatic prostate cancer: a 'young' concept for old patients?

Prostate cancer is a common disease in the elderly, and the number of older prostate cancer patients will probably increase with both the aging of the population and the increased rate of screening. In elderly patients with several co-morbidities, cancer management can be complex, and the risk of administering toxic therapy in this setting should be carefully evaluated. Metronomic chemotherapy, i.e. low-dose, long-term, frequently administered chemotherapy, has been shown to have a significant stabilizing effect on cancer and a positive impact on the quality of life of patients, including those with prostate cancer. Given the low toxicity profile of metronomic chemotherapy, elderly patients or patients with co-morbidities may be candidates for a first-line or second-line oral metronomic approach when standard chemotherapies are contraindicated or not acceptable to the patient. Moreover, the possibility of patients being able to spend more time at home is an important component of a palliative treatment such as metronomic chemotherapy. Unfortunately, and despite these considerations, very few data are available on the activity and safety of metronomic chemotherapy in elderly patients. However, retrospective analyses conducted in a small cohort of patients have been published and, notwithstanding their limitations, indicate that novel metronomic schedules are well tolerated, safe and show potentially interesting activity in elderly, 'unfit' (poor performance status) patients with metastatic prostate cancer. Therefore, evaluation of metronomic chemotherapy strategies in prospective, randomized, phase II/III clinical studies of elderly patients with metastatic prostate cancer appears to be warranted.