Docetaxel Versus Androgen-Receptor Signaling Inhibitors as Second-Line Therapy After Failure of First-Line Alternative ARSI for the Elderly ≥ 75 Years Old With Metastatic Castration-Resistant Prostate Cancer

An increasing proportion of patients with advanced prostate cancer are men aged ≥75 years, yet they remain commonly underrepresented in clinical trials. Selecting the optimal sequence of treatments for these patients can be challenging due to their typical frailty, comorbidities, and the paramount need to consider their quality of life.

Results from this multicenter real-world analysis suggest that using an alternative ARPI as second-line therapy for mCRPC, following the failure of a first-line ARPI, may be as effective as docetaxel. Dedicated larger prospective trials are warranted to validate this data. However, given the lack of data in the literature and the fact that chemotherapy-related adverse events can significantly impact the quality of life for elderly patients, these findings may guide physicians to consider a second-line ARPI instead of docetaxel.

Written by: Edoardo Francini, MD, PhD, Associate Professor of Medical Oncology, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla Florence, Italy

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