title: Metronomic chemotherapy for metastatic prostate cancer: a 'young' concept for old patients?
abstract: 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.
authors.affiliation: Unit of Medical Oncology 2, Azienda-Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fontana
authors.forename: Alfredo
authors.initials: A
authors.lastname: Falcone
authors.forename: Lisa
authors.initials: L
authors.lastname: Derosa
authors.forename: Teresa
authors.initials: T
authors.lastname: Di Desidero
authors.forename: Romano
authors.initials: R
authors.lastname: Danesi
authors.forename: Guido
authors.initials: G
authors.lastname: Bocci
mesh_terms: 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*
references.citation: Br J Cancer. 2008 Apr 22;98(8):1312-9
references.pmid: 18362940
references.citation: J Clin Oncol. 2008 Jan 1;26(1):76-82
references.pmid: 18165643
references.citation: J Urol. 2007 Jun;177(6):2136-40; discussion 2140
references.pmid: 17509300
references.citation: Tumori. 2007 Nov-Dec;93(6):647
references.pmid: 18338509
references.citation: CA Cancer J Clin. 2009 Jul-Aug;59(4):225-49
references.pmid: 19474385
references.citation: Eur Urol. 2009 Jun;55(6):1368-75
references.pmid: 18706755
references.citation: Tumori. 2009 Jan-Feb;95(1):130; author reply 131
references.pmid: 19366074
references.citation: Nat Clin Pract Urol. 2009 Feb;6(2):76-85
references.pmid: 19198621
references.citation: Proc Natl Acad Sci U S A. 2003 Oct 28;100(22):12917-22
references.pmid: 14561896
references.citation: Nat Rev Clin Oncol. 2010 Jan;7(1):13-21
references.pmid: 19997075
references.citation: Cancer Immunol Immunother. 2007 May;56(5):641-8
references.pmid: 16960692
references.citation: Curr Opin Support Palliat Care. 2007 Oct;1(3):187-91
references.pmid: 18685361
references.citation: Ann Oncol. 2005 Aug;16(8):1243-52
references.pmid: 15905308
references.citation: Cancer Res. 2002 May 15;62(10):2731-5
references.pmid: 12019144
references.citation: J Clin Oncol. 2008 Jan 10;26(2):242-5
references.pmid: 18182665
references.citation: Semin Oncol. 2008 Dec;35(6):597-617
references.pmid: 19027464
references.citation: Ann Hematol. 2009 Dec;88(12):1257-9
references.pmid: 19330332
references.citation: Cancer Treat Rev. 2009 Oct;35(6):522-7
references.pmid: 19487081
references.citation: Nihon Ronen Igakkai Zasshi. 2009 May;46(3):264-8
references.pmid: 19521048
references.citation: Invest New Drugs. 2010 Oct;28(5):684-9
references.pmid: 19669699
references.citation: Cancer Chemother Pharmacol. 2009 Jun;64(1):189-93
references.pmid: 19151974
references.citation: Clin Cancer Res. 2009 Aug 1;15(15):4954-62
references.pmid: 19622584
references.citation: N Engl J Med. 2004 Oct 7;351(15):1513-20
references.pmid: 15470214
references.citation: Anticancer Drugs. 2006 Sep;17(8):961-7
references.pmid: 16940806
references.citation: Cancer. 2003 Oct 15;98(8):1643-8
references.pmid: 14534880
references.citation: Med Oncol. 2010 Jun;27(2):363-7
references.pmid: 19365737
references.citation: J Am Geriatr Soc. 2010 May;58(5):986-8
references.pmid: 20722827
references.citation: Clin Prostate Cancer. 2003 Dec;2(3):167-72
references.pmid: 15040860
references.citation: N Engl J Med. 2004 Oct 7;351(15):1502-12
references.pmid: 15470213
references.citation: J Clin Oncol. 2008 Oct 20;26(30):4899-905
references.pmid: 18794539