934P - Efficacy and tolerability of taxane-based chemotherapy in senior adults with metastatic castration-resistant prostate cancer (mCRPC): a prospective...

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anti-Cancer Agents & Biologic Therapy
Geriatric Oncology
Prostate Cancer
Presenter Jean-Pierre Droz
Authors J. Droz1, E. Efstathiou2, A. Heidenreich3, A. Yildirim4, P. Cabrera5, C. Kim6, A. Horchani7, J.A. Rinck Jr8, H. Ozen9
  • 1Medical Oncology, Centre Leon Bérard, 69008 - Lyon CEDEX/FR
  • 2Oncology, University of Texas MD Anderson Cancer Center, TX77030 - HOUSTON/US
  • 3Urology, RWTH Aachen University, 50274 - Aachen/DE
  • 4Oncology, SB Göztepe Training and Research Hospital, 34742 - ISTANBUL/TR
  • 5Oncology, Centro Oncologico ISSEMyM, 50180 - TOLUCA/MX
  • 6Urology, Asan Medical Center, 138736 - SEOUL/KR
  • 7Urology, La Rabta Hospital, 1007 - Tunis/TN
  • 8Medical Oncology, Hospital A. C. Camargo, BR-01509-010 - Sao Paulo/BR
  • 9Urology, Hacettepe University Medical Faculty, 06100 - Ankara/TR

Abstract

Background

Docetaxel every 3 weeks is the standard of care in mCRPC, although other chemotherapy regimens may be administered. Efficacy and toxicity of taxanes in older men (70+ y) is poorly documented. Their enrolment in randomized trials is limited by exclusion criteria related to performance status (PS) and comorbidities. This prospective international registry evaluates taxane toxicity and efficacy in such men in real life practice.

Methods

333 men with mCRPC (median age 76 y) were evaluated. PS, grade 3-4 comorbidities (Cumulative Illness Scoring Rate-Geriatrics), dependence (Activity Daily Living [ADL], Instrumental ADL [IADL]), nutritional status, primary therapy received and outcomes (overall survival (OS), progression-free survival (PFS), best clinical benefit [based on pain, analgesic consumption, PS], PSA response, toxicity) were collected. Follow-up under therapy was 6 months.

Results

In all, 24.0% had PS ≥2, 13.5% grade 3-4 comorbidities, 21% were dependent in ≥1 IADL, 15.6% in ≥1 ADL and 12.8% had a weight loss ≥5% within the past 3 months. According to SIOG (International Society of Geriatric Oncology) algorithm, 65.2% were fit, 13.5% vulnerable, 16.8% frail and 4.5% had terminal illness. Most men (62.4%) had pain at enrolment. Primary therapy was a taxane in 58% (3-weekly, 84.4%; median, 5 months) and received another therapy (hormonal therapy alone in 23.7%, non-taxane chemotherapy in 10.6%). Clinical characteristics of men treated by taxanes and other therapies were comparable at baseline. At 6 months, 91% were still alive with taxanes vs 81% with other therapies (HR [95% CI] 0.53 [0.30-0.93] p = 0.027). Frail patients showed the greatest benefit in OS (83% vs 57%, HR 0.32 [0.11-0.91] p = 0.033). Taxanes also significantly increased PFS (66% vs 50%, HR 0.55 [0.40-0.76], p < 0.001), best clinical benefit (60% vs 36%, HR 2.05 [1.47-2.85], p < 0.001) and PSA response ≥50% (52.5% vs 37.4%, p = 0.018), including in frail patients. Main grade 3-4 toxicities with taxanes were fatigue (17.1%), nausea/vomiting (14%), diarrhoea (8.8%), anaemia (7.8%), nail change (6.7%) and febrile neutropenia (2.6%).

Conclusions

Taxanes appear the most effective first-line therapy in older men with mCRPC and show an acceptable and manageable toxicity, including in frail patients.

Droz et al. BJU Int 2010; 106: 462-69

Disclosure

J. Droz: Member of Advisory Board on Prostate Cancer- SANOFI,

A. Heidenreich: Advisory relationship for Astellas, Janssen Cilag, Sanofi, Ipsen, Takeda Honoraria received from Amgen, Astellas, Glaxo, Ipsen, Jansen Cilag, Pfizer, Sanofi, Takeda.

All other authors have declared no conflicts of interest.