Prostate cancer news update: Monday, August 25

Two reports just published would appear to confirm individual patient experiences in the treatment of advanced disease:

  • The impact of ADT on body composition
  • The effects of docetaxel chemotherapy in men aged ≥ 75 years

van Londen et al., recognizing the lack of research into the long-term impact of androgen deprivation therapy (ADT) on body composition in men with prostate cancer, measured body fat mass and lean body mass prospectively in 81 men with prostate cancer on no ADT, 43 men on acute ADT (for < 6 months), 67 men on chronic ADT (> 6 months), and 53 age-matched healthy controls. Measurements were performed every 6 months for 2 years. They found that men with prostate cancer on acute ADT (mean 3 months) had significant gains in body fat mass (1499.56 ± 322.28 g after 12 months, 2167.15 ± 676.45 g after 24 months) and losses in lean body mass (929.74 ± 296.36 g after 12 months, 1785.81 ± 501.31 g after 24 months) over 2 years. Men on chronic ADT (mean 31 months) had smaller but still significant body composition changes over 24 months. Changes in body composition in men on no ADT were small and healthy controls had no significant changes. These data would appear to confirm the personal experiences of many men undergoing ADT.

The risks associated with the use of docetaxel (Taxotere) chemotherapy in elderly men (> 75 years of age) has been investigated by Italiano et al. They reviewed the clinical files of 175 patients aged ≥ 75 years with castration-resistant prostate cancer (CRPC) treated with first-line docetaxel in nine French tertiary care cancer centres from 2000 to 2007. Median patient age was 78 years. Ninety-five patients (54 percent) received a standard 3-week regimen (SR), and 80 patients (46 percent) received an adapted regimen (AR) delivered on a weekly schedule with various times for rest periods. Patients treated with an AR were older (>80 years) and had poorer performance status (PS ≥ 2) than patients treated with the SR. The PSA response rates were not significantly different between the SR and AR treatment groups (71 vs 68 percent). The median progression-free survival (PFS) was 7.4 months. The median overall survival (OS) was 15 months. The incidence of grade 3 or 4 adverse events was 46 percent and was correlated with poor PS and the presence of visceral disease but not with the regimen. Early discontinuation of treatment because of toxicity occurred significantly more frequently in the AR group than in the SR group (30 vs 8.4 percent). Italiano et al . conclude that docetaxel is active and feasible in elderly patients with good PS but that the optimal treatment of frail patients with CRPC remains to be established. They suggest that geriatric assessment tools should be used to more accurately detect elderly CRPC patients who are unfit for chemotherapy, and that age by itself should not be used as a criterion to deny patients with CRPC a potentially effective chemotherapy.

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