Jean-Pierre Droz1, Eleni Efstathiou2, Asif Yildirim3, Paula Cabrera4, Choung Soo Kim5, Ali Horchani6, Axel Heidenreich7, José Augusto Rinck-Junior8, Simon Hitier9, Haluk Ӧzen10. 1. Department of Cancer Environment Research Unit, Léon-Bérard Cancer Center, Claude-Bernard-Lyon1 University, Lyon, France. Electronic address: jpdroz@orange.fr. 2. Department Medical Oncology, University of Athens, Athens, Greece. 3. Department of Urology, SB Göztepe Training and Research Hospital, Istanbul, Turkey. 4. Department of Urology, Instituto Nacional de Cancerología, Mexico City, Mexico. 5. Department of Urology, Asan Medical Center, Songpa-Gu, Seoul, Korea. 6. Department of Urology, Faculty of Medicine, La Rabta Hospital, Tunis, Tunisia. 7. Department of Urology, Universitätsklinikum Aachen, Aachen, Germany. 8. Department of Urology, Hospital do Cancer-A.C. Camargo, Sao Paulo, Brazil. 9. Sanofi Oncology, Paris, France. 10. Department of Urology, Hacettepe University, Ankara, Turkey.
Abstract
AIMS: To compare the efficacy and tolerability of taxane and nontaxane therapy in senior adults with chemonaïve metastatic castration-resistant prostate cancer (mCRPC), and examine the effect of patient health status on outcomes. PATIENTS AND METHODS: Between 2009 and 2011, 333 patients aged≥70 years with mCRPC were enrolled in a prospective international registry. Patients were categorized as having received taxane-based or nontaxane therapy, and classified as fit, vulnerable, frail, or terminal, according to investigator judgement or International Society of Geriatric Oncology guidelines. Efficacy measures included overall survival (OS) and progression-free survival. Grade 3/4 toxicities were recorded. Predictors of OS were identified using multivariate Cox regression. RESULTS: The proportions of fit/vulnerable/frail patients were 65%/14%/17% (International Society of Geriatric Oncology), and 39%/43%/17% (investigator). In single-factor analyses, taxane therapy improved OS (hazard ratio [95%CI] = 0.53 [0.30-0.93]; P = 0.027) and progression-free survival (hazard ratio [95% CI] = 0.55 [0.40-0.76]; P<0.001) vs. nontaxane therapy. Patients with frailty also benefited from taxane therapy (adapted regimen in 52%). In multivariate analysis, taxanes improved OS even with poor prognostic factors present (P = 0.017); age was unrelated to prognosis. Taxane therapy was well tolerated; most common grade 3/4 toxicities (taxane vs. nontaxane) were fatigue (17% vs. 4%), nausea/vomiting (14% vs. 5%) and neutropenia (10% vs. 1%). CONCLUSIONS: The results of this nonrandomized, observational study suggest that first-line taxane therapy may benefit senior adults with mCRPC more than alternative therapies. Treatment decisions should not be based on chronological age.
AIMS: To compare the efficacy and tolerability of taxane and nontaxane therapy in senior adults with chemonaïve metastatic castration-resistant prostate cancer (mCRPC), and examine the effect of patient health status on outcomes. PATIENTS AND METHODS: Between 2009 and 2011, 333 patients aged≥70 years with mCRPC were enrolled in a prospective international registry. Patients were categorized as having received taxane-based or nontaxane therapy, and classified as fit, vulnerable, frail, or terminal, according to investigator judgement or International Society of Geriatric Oncology guidelines. Efficacy measures included overall survival (OS) and progression-free survival. Grade 3/4 toxicities were recorded. Predictors of OS were identified using multivariate Cox regression. RESULTS: The proportions of fit/vulnerable/frail patients were 65%/14%/17% (International Society of Geriatric Oncology), and 39%/43%/17% (investigator). In single-factor analyses, taxane therapy improved OS (hazard ratio [95%CI] = 0.53 [0.30-0.93]; P = 0.027) and progression-free survival (hazard ratio [95% CI] = 0.55 [0.40-0.76]; P<0.001) vs. nontaxane therapy. Patients with frailty also benefited from taxane therapy (adapted regimen in 52%). In multivariate analysis, taxanes improved OS even with poor prognostic factors present (P = 0.017); age was unrelated to prognosis. Taxane therapy was well tolerated; most common grade 3/4 toxicities (taxane vs. nontaxane) were fatigue (17% vs. 4%), nausea/vomiting (14% vs. 5%) and neutropenia (10% vs. 1%). CONCLUSIONS: The results of this nonrandomized, observational study suggest that first-line taxane therapy may benefit senior adults with mCRPC more than alternative therapies. Treatment decisions should not be based on chronological age.
Authors: Peter Arnold; Maria Cristina Penaloza-Ramos; Lola Adedokun; Sarah Rees; Mohamed Lockhat; Lisa Spary; Alan Watkins; Vincent Gnanapragasam; Simon J Crabb Journal: Sci Rep Date: 2021-11-12 Impact factor: 4.379