Safety and outcomes of new generation hormone-therapy in elderly chemotherapy-naive metastatic castration-resistant prostate cancer patients in the real world

• Published in: Archives of gerontology and geriatrics 2019-05, Vol.82, p.179-185
• Main Authors: Beardo, Pastora, Osman, Ignacio, San José, Begoña, Llarena, Roberto, Congregado, Belén, Campá, Josep, Medina-López, Rafael A., Extramiana, Javier
• Format: Article
• Language: English
• Subjects: Abiraterone acetate; Abiraterone Acetate - therapeutic use; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Castration resistant prostate cancer; Chemo-naive; Disease-Free Survival; Elderly; Enzalutamide; Humans; Male; Middle Aged; Overall survival; Phenylthiohydantoin - analogs & derivatives; Phenylthiohydantoin - therapeutic use; Prognosis; Prostatic Neoplasms, Castration-Resistant - drug therapy; Retrospective Studies
• ISSN: 0167-4943; 1872-6976
• DOI: 10.1016/j.archger.2019.02.008

•Many real-world metastatic castration-resistant cancer patients are >75 years old.•Age does not influence treatment duration or overall survival.•Rates of adverse events of treatment do not differ with age.•Elderly patients with ECOG 0 and/or G8 score >14 have longer overall survival. Abiraterone acetate and enzalutamide are standard treatments for chemotherapy-naive metastatic castration-resistant prostate cancer (CN-mCRPC). The purpose of this study was to evaluate the effectiveness and safety of these medications in elderly (≥ 75 years old) compared with young CN-mCRPC patients in a real-world clinical setting. Secondarily, we explored the survival prognostic value of different anatomo-clinical factors in elderly group. In this retrospective observational multicentre study, we included 134 consecutive CN-mCRPC patients, 64 young and 70 elderly men, who had received AA or Enz. We did not find significant differences in treatment duration [16.6 months, (95% CI 9–24.2 months) vs. 16.8 months (95% CI: 6.3–27.2 months); p = 0.926] and overall survival [median not reached vs. 23.3 months (95% CI 10.2–36.3 months); p = 0.131] between the young and elderly groups. In elderly group, the only predictors of overall survival with AA or Enz were good ECOG performance status and high G8 score. Adverse events of grade ≥3 was similar in elderly group (12.9%) and in the young group (15.6%). Treatment was discontinued due to AEs in 6.3% of young group and 18.6% of elderly group. Effectiveness and safety of treatment of CN-mRCPC with Abiraterone acetate and enzalutamide were similar in older and younger patients, although treatment discontinuation due to AEs was more frequent in the older age group. In addition to ECOG PS, assessment using specific geriatric scales as G8 screening tool could help to identify patients aged ≥75 who would most benefit from treatment with new-generation hormone therapy.