Clinical trials for treatment of men with advanced prostate cancer often don’t include men who are considered very elderly (aged over 80 years). So, even if we know that a treatment is tolerable and effective in the average man, we can not assume that it would also be in the very elderly, especially in reference to its tolerability.
Many men who are over 80 years are considered for treatment with chemotherapy with docetaxel. However, is docetaxel a good choice of a drug for men who are very elderly, we don’t have any research answering this important question.
A retrospective study was performed in Melbourne, Australia to evaluate the use of docetaxel in this very elderly population of men with metastatic castration-resistant prostate cancer (mCRPC) treated in routine clinical care. The study involved twenty men with a median age of 83 years (range 80-93 years). Aside from one patient treated weekly, all patients were treated with a 3-weekly regimen of docetaxel with a median of six cycles (range 1-10 cycles).
Eight men (40%) had an initial dose reduction and 11 men (55%) had subsequent dose delays or reductions. Eight men (40%) completed planned treatment.
Grade 3/4 hematologic toxicity was observed in nine men (45%), and five men (25%) were admitted to hospital with chemotherapy-related complications.
Prostate-specific antigen (PSA) response was assessable for 16 men, of whom nine (56%) had a PSA response of greater than 50% and one (6%) had a PSA-complete response. The median overall survival in this cohort was 13.4 months.
The researchers concluded that in this very elderly cohort of men (80 + years) with mCRPC have a significant response rate to docetaxel chemotherapy, but that a substantial number of the men had treatment-related complications. These findings highlight the need for careful patient selection and optimization of chemotherapy dosing specific to each individual.