title: Chemotherapy in frail elderly patients with hormone-refractory prostate cancer: A "real world" experience.
abstract: BACKGROUND
  In elderly patients affected by metastatic castration-resistant prostate cancer (mCRPC) chemotherapic treatment may be the choice if one considers not only the chronological age, but also the clinical status, the functional reserve, and the vulnerability of patients. Several studies have confirmed the survival benefit of docetaxel and vinorelbine among every class of age. Most CRP elderly patients are defined as frail, maybe due to comorbidities: these patients, who are unable to be candidates for a standard treatment, should be candidates for a more tolerable treatment.
  
  
  METHODS
  Twenty-six elderly, frail patients were evaluated. The patients were affected by mCRPC and were receiving chemotherapy with intravenous weekly docetaxel (12 patients) or oral metronomic vinorelbine (14 patients). Safety and efficacy were investigated evaluating clinical and objective response and tolerability. The level of patient satisfaction with treatment was assessed through a questionnaire.
  
  
  RESULTS
  No significant difference was found between groups in terms of 6-month progression-free survival: 57.1% for patients treated with oral metronomic vinorelbine versus 58.3% for patients treated with docetaxel. Median progression free survival was 8.6 months (95% confidence interval: 7.1-9.4 months), and 8.2 months (95% confidence interval: 6.9-9.3 months) for patients treated with oral metronomic vinorelbine and socetaxel, respectively. Oral metronomic vinorelbine was associated with increased patient satisfaction with respect to docetaxel administration. The most frequent side effect associated with oral metronomic vinorelbine was anemia and vomiting, with similar frequency compared to patients treated with docetaxel.
  
  
  CONCLUSIONS
  Weekly docetaxel and oral metronomic vinorelbine are equally effective and well tolerated in elderly unfit and frail patients affected by mCRPC. Metronomic vinorelbine treatment is associated with higher patient compliance and satisfaction.
authors.affiliation: Umberto I Hospital, Medical Oncology Unit - Rete Assisstenza Oncologica, Siracusa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tralongo
authors.affiliation: Umberto I Hospital, Medical Oncology Unit - Rete Assisstenza Oncologica, Siracusa, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Bordonaro
authors.affiliation: Umberto I Hospital, Medical Oncology Unit - Rete Assisstenza Oncologica, Siracusa, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Di Mari
authors.affiliation: Umberto I Hospital, Medical Oncology Unit - Rete Assisstenza Oncologica, Siracusa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cappuccio
authors.affiliation: Umberto I Hospital, Medical Oncology Unit - Rete Assisstenza Oncologica, Siracusa, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Rametta Giuliano
keywords: Cancer; Chemotherapy; Elderly; Frail; Prostate