ONCAlert | Upfront Therapy for mRCC

Challenges in the Optimal Therapeutic Management of Geriatric Patients

Published Online: Apr 20,2016
Prostate cancer is the most commonly diagnosed cancer among men and is the second leading cause of cancer-related deaths.1 It is most frequently diagnosed in men age 65 to 74 years, with nearly 90% of all new cases diagnosed in men age ≥55 years.2

Given the demographic distribution of patients with prostate cancer, clinicians must consider and evaluate the unique characteristics and treatment options for this population. Unlike younger men, older men are more likely to be diagnosed with advanced disease, and tend to have higher mortality rates and poorer prognosis.3

Many older patients with prostate cancer are treated with systemic therapies, stressing the importance of evaluating clinical outcomes and safety profiles specifically in the elderly. Treating elderly patients presents certain challenges, including higher rates of comorbidities, physical frailty, and lower tolerance for adverse events (AEs). Several recent studies have investigated the safety and efficacy of next-generation antiandrogen therapies and chemotherapy in the geriatric population.

Studies With Abiraterone Acetate

Peter Mulders, MD, PhD, Radboud University Medical Center, Nijmegen, The Netherlands, and colleagues reported their findings of abiraterone acetate in elderly patients who had received prior chemotherapy in European Urology.4

In a post hoc analysis of the COU-AA-301 trial,5,6 the pivotal study that led to the approval of abiraterone acetate in patients who had received prior docetaxel, the efficacy and safety of abiraterone acetate (AA) plus prednisone was compared with placebo plus prednisone in younger (<75 years) and elderly (≥75 years) patients.

Abiraterone acetate, the prodrug of abiraterone, is an inhibitor of CYP17A that targets extragonadal synthesis of androgen. Since 2011, it has been approved for use in patients with metastatic castration-resistant prostate cancer (mCRPC) who have received prior docetaxel therapy, and since 2012 for patients who are chemotherapy-naìˆve (TABLE 1).7

Compared with patients who received placebo plus prednisone, overall survival (OS) was significantly improved with AA plus prednisone in elderly patients (15.6 vs 9.3 months; P =.0022) and younger patients (15.9 vs 12.0 months; P =.0055). Similarly, AA plus prednisone significantly improved radiographic progression-free survival (PFS) in both elderly (6.6 vs 5.4 months; P =.0019) and younger (5.6 vs 3.0 months; P <.0001) patients, as well as time to prostate-specific antigen (PSA) progression (TTPP) in younger patients (8.4 vs 5.6 months; P <.0001).4

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Challenges in the Optimal Therapeutic Management of Geriatric Patients
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