Metronomic chemotherapy for metastatic prostate cancer: a 'young' concept for old patients?
Prostate cancer is a common disease in the elderly, and the number of older prostate cancer patients will probably increase with both the aging of the population and the increased rate of screening. In elderly patients with several co-morbidities, cancer management can be complex, and the risk of administering toxic therapy in this setting should be carefully evaluated. Metronomic chemotherapy, i.e. low-dose, long-term, frequently administered chemotherapy, has been shown to have a significant stabilizing effect on cancer and a positive impact on the quality of life of patients, including those with prostate cancer. Given the low toxicity profile of metronomic chemotherapy, elderly patients or patients with co-morbidities may be candidates for a first-line or second-line oral metronomic approach when standard chemotherapies are contraindicated or not acceptable to the patient. Moreover, the possibility of patients being able to spend more time at home is an important component of a palliative treatment such as metronomic chemotherapy. Unfortunately, and despite these considerations, very few data are available on the activity and safety of metronomic chemotherapy in elderly patients. However, retrospective analyses conducted in a small cohort of patients have been published and, notwithstanding their limitations, indicate that novel metronomic schedules are well tolerated, safe and show potentially interesting activity in elderly, 'unfit' (poor performance status) patients with metastatic prostate cancer. Therefore, evaluation of metronomic chemotherapy strategies in prospective, randomized, phase II/III clinical studies of elderly patients with metastatic prostate cancer appears to be warranted.
Fontana
Andrea
A
Unit of Medical Oncology 2, Azienda-Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy.
Falcone
Alfredo
A
Derosa
Lisa
L
Di Desidero
Teresa
T
Danesi
Romano
R
Bocci
Guido
G
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology*
Br J Cancer. 2008 Apr 22;98(8):1312-9
18362940
J Clin Oncol. 2008 Jan 1;26(1):76-82
18165643
J Urol. 2007 Jun;177(6):2136-40; discussion 2140
17509300
Tumori. 2007 Nov-Dec;93(6):647
18338509
CA Cancer J Clin. 2009 Jul-Aug;59(4):225-49
19474385
Eur Urol. 2009 Jun;55(6):1368-75
18706755
Tumori. 2009 Jan-Feb;95(1):130; author reply 131
19366074
Nat Clin Pract Urol. 2009 Feb;6(2):76-85
19198621
Proc Natl Acad Sci U S A. 2003 Oct 28;100(22):12917-22
14561896
Nat Rev Clin Oncol. 2010 Jan;7(1):13-21
19997075
Cancer Immunol Immunother. 2007 May;56(5):641-8
16960692
Curr Opin Support Palliat Care. 2007 Oct;1(3):187-91
18685361
Ann Oncol. 2005 Aug;16(8):1243-52
15905308
Cancer Res. 2002 May 15;62(10):2731-5
12019144
J Clin Oncol. 2008 Jan 10;26(2):242-5
18182665
Semin Oncol. 2008 Dec;35(6):597-617
19027464
Ann Hematol. 2009 Dec;88(12):1257-9
19330332
Cancer Treat Rev. 2009 Oct;35(6):522-7
19487081
Nihon Ronen Igakkai Zasshi. 2009 May;46(3):264-8
19521048
Invest New Drugs. 2010 Oct;28(5):684-9
19669699
Cancer Chemother Pharmacol. 2009 Jun;64(1):189-93
19151974
Clin Cancer Res. 2009 Aug 1;15(15):4954-62
19622584
N Engl J Med. 2004 Oct 7;351(15):1513-20
15470214
Anticancer Drugs. 2006 Sep;17(8):961-7
16940806
Cancer. 2003 Oct 15;98(8):1643-8
14534880
Med Oncol. 2010 Jun;27(2):363-7
19365737
J Am Geriatr Soc. 2010 May;58(5):986-8
20722827
Clin Prostate Cancer. 2003 Dec;2(3):167-72
15040860
N Engl J Med. 2004 Oct 7;351(15):1502-12
15470213
J Clin Oncol. 2008 Oct 20;26(30):4899-905
18794539