Clinical management of elderly patients with metastatic prostate cancer chemotherapy

Abstract

Docetaxel and cabazitaxel chemotherapy have modestly extended survival as firstor second-line chemotherapy for patients with metastatic castration-resistant prostate cancer. Mitoxantrone chemotherapy may continue to play a palliative role in selected patients. In general, elderly age alone does not preclude chemotherapy or other therapies in patients that qualify based on a satisfactory biologic age, i.e., with no serious uncontrolled comorbidities, ECOG performance status 0-2, adequate organ and cognitive function, and satisfactory nutritional status and social support. Despite trends for increasing toxicities, selected elderly patients appear to generally tolerate chemotherapy and derive benefits similar to their younger counterparts. However, given the increased prevalence of comorbidities, functional impairments, and organ dysfunctions in the elderly, careful selection of patients coupled with dose modifications and prophylactic measures to avoid toxicities is necessary. Trials are also investigating the role of docetaxel for earlier stages of prostate cancer and comparing docetaxel with cabazitaxel as first-line chemotherapy. In the context of an increasing pipeline of novel approved agents (abiraterone acetate, sipuleucel-T) and emerging agents (radium-223, MDV-3100), optimal survival will probably be realized by the sequential utilization of several different classes of agents.