title: Analysis of docetaxel therapy in elderly (≥70 years) castration resistant prostate cancer patients enrolled in the Netherlands Prostate Study.
abstract: BACKGROUND
  Prostate cancer truly is an age-associated disease. Due to the increased life expectancy and more sensitive diagnostic techniques in the Western world, prostate cancer is diagnosed more frequently and with rapidly increasing incidence and prevalence rates. However, age above 65 or 70 years has been an exclusion criterion in clinical trials for decades and the knowledge about chemotherapy tolerance in elderly is limited.
  
  
  METHODS
  We performed a retrospective analysis of data acquired from the recently published Netherlands Prostate Study (NePro) to evaluate the influence of advanced age on docetaxel therapy in elderly men (>70 years) with castration resistant prostate cancer (CRPC) and bone metastases. Statistical analyses were performed stratified for age into four categories: <70 (n=315), 70-74 (n=150), 75-79 (n=85), and ≥80 years old (n=18).
  
  
  RESULTS
  We analysed 568 patients (median age 68.1 years, range 46-89 years, 44.5% aged ≥70 years). There was no relation between dosage and age (p=0.60). We found no significant differences between the number of dose reductions, time to progression (TTP), overall survival, chemotherapy tolerance and toxicity up to the age of 80 years. However, when compared to younger men, men aged 80 years or above more frequently experienced grade 3/4 toxicity and were five times less likely to complete the first three treatment cycles at the intended dose (Odds ratio (OR) 5.34, p=0.0052) and showed decreased overall survival (15.3 months versus 24.5 months in <80 years group, p=0.020).
  
  
  CONCLUSIONS
  In CRPC patients up to the age of 80 years, docetaxel chemotherapy is well tolerated, with toxicity levels and TTP comparable to those of younger patients. For chemotherapeutic treatment of patients above the age of 80 years an individual assessment should be made.
authors.affiliation: Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: F L
authors.initials: FL
authors.lastname: Gerritse
authors.forename: H J
authors.initials: HJ
authors.lastname: Meulenbeld
authors.forename: J M L
authors.initials: JM
authors.lastname: Roodhart
authors.forename: A M T
authors.initials: AM
authors.lastname: van der Velden
authors.forename: R J B
authors.initials: RJ
authors.lastname: Blaisse
authors.forename: T J
authors.initials: TJ
authors.lastname: Smilde
authors.forename: Z
authors.initials: Z
authors.lastname: Erjavec
authors.forename: R
authors.initials: R
authors.lastname: de Wit
authors.forename: M
authors.initials: M
authors.lastname: Los
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D000077143:Docetaxel; D012968:Etidronic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009426:Netherlands; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D000068296:Risedronic Acid; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D000068296:Risedronic Acid; D012968:Etidronic Acid; D011241:Prednisone
keywords: Chemotherapy; Docetaxel; Elderly; Geriatric oncology; Metastases; Prostate cancer; Toxicity