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ESMO 2020

ESMO Virtual Congress 2020: Quality of Life and Survival in Elderly Metastatic Castration-Resistant Prostate Cancer Patients Treated with Docetaxel

(UroToday.com) Though the clinical trials leading to approval of life-prolonging therapies in metastatic castrations resistant prostate cancer (mCRPC) included a substantial minority of patients over the age of 75, the efficacy and impact on the quality of life in more senior patients is not clearly established. To gather more information on this question, the authors of this poster performed a retrospective analysis of three clinical trials with control arms of docetaxel therapy (MAINSAIL, ENTHUSE, and VENICE). An age cut-off of 75 was used to delineate groups, and differences in overall survival, as well as the quality of life as assessed by greater than 10 point decrease in FACT-P score, were compared between groups. Covariates for analysis included pain, performance status, and lab values for hemoglobin, albumin, lactate dehydrogenase, and alkaline phosphatase.

Patient characteristics are shown below. A total of 1,607 patients were included in the overall survival analysis and 1,455 patients in the FACT-P analysis.

Perez_-_640P_-_ESMO20_-_Figure_1.png

The median survival of the whole cohort regardless of age was 19.8 months, and the median time to progression of FACT-P score was 10.1 months.

In this cohort, overall survival and time to progression of FACT-P score were lower in patients older than 75. The median overall survival was 19.5 months in patients younger than 75 and 16.6 months in patients older than 75. The median time to FACT-P progression was 11 months in patients younger than 75 and 7.5 months in patients older than 75.

Perez_-_640P_-_ESMO20_-_Figure_2.png

When utilizing a multivariable Cox-regression model including the covariates listed above, the association between age at a cutoff of 75 and overall survival was not statistically significant (HR 1.13, HR = 0.231). However, the association between age greater than 75 and worsening of FACT-P score was significant (HR 1.55, p = 0.0001).

In summary, while numerically lower, overall survival was not significantly different in this retrospective analysis between patients younger or older than 75 receiving docetaxel for mCRPC. Patients older than 75 had a significantly shorter time to worsening in quality of life as assessed by FACT-P score. Optimal treatment regimens that focus both on survival and quality of life in patients, especially those older than 75, are critical to maximizing the quality and quantity of life in patients with mCRPC.  

Presented by: Irene Paredero Perez, MD, Medical Oncology Department, Consorcio Hospitalario Provincial de Castellon, Castellon De La Plana, Spain

Written by: Alok Tewari, MD, Ph.D., Medical Oncologist at the Dana-Farber Cancer Institute, at the 2020 European Society for Medical Oncology Virtual Congress (#ESMO20), September 19th-September 21st, 2020