Massachusetts General Hospital Cancer Center, Boston, MA, USA.
Dana-Farber Cancer Institute, Boston, MA, USA.
Prostate Cancer Prostatic Dis. 2021 Dec;24(4):1181-1188. doi: 10.1038/s41391-021-00389-2. Epub 2021 May 18.
Most men who die of prostate cancer are older than 70 years. The ChemoHormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer (CHAARTED) randomized men of all ages with metastatic hormone-sensitive prostate cancer (mHSPC) to receive androgen deprivation therapy (ADT) with or without docetaxel demonstrating an overall survival (OS) benefit for docetaxel.
In a post-hoc analysis of this trial, we assessed patient characteristics and OS in patients ≥70 years ("older men") versus <70 years ("younger men") with Cox proportional hazards models. In addition, we compared adverse events, therapy completion rate, and subsequent treatment patterns between these two groups using Chi-squared tests.
177 (22.4%) patients were ≥70 years. Docetaxel + ADT resulted in improved OS in both older and younger men (Hazard Ratio [HR] 0.45, 95%CI: 0.25-0.80 for older men; HR 0.71, 95%CI: 0.53-0.95 for younger men). This treatment benefit was seen for subgroups of older men with high volume disease (HR 0.43, 95%CI 0.23-0.79) and de novo metastatic disease (HR 0.36, 95%CI 0.19-0.69). A similar proportion of older and younger men completed six cycles of docetaxel (82.6% vs. 87.1%, p = 0.28). Rates of grade 3-5 adverse events were similar between older and younger men (36.8% vs. 26.8%, respectively, p = 0.069). The rate of any Grades 4-5 adverse events did not differ significantly between older and younger men (14.9% vs. 11.9%, respectively, p = 0.46). In the control arm, a smaller proportion of older men received subsequent cancer treatments (34.4% vs. 51.5%, p = 0.017) or subsequent docetaxel (25.6% vs. 37.6%, p = 0.035) compared to younger men.
Older men with mHSPC had similar OS benefit and clinical outcomes compared to younger men when receiving docetaxel + ADT. Oncologists should consider docetaxel chemotherapy as a favorable treatment option for older men with mHSPC who are fit for chemotherapy.
大多数死于前列腺癌的男性年龄都在 70 岁以上。在 ChemoHormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer（CHAARTED）研究中，所有年龄的转移性激素敏感型前列腺癌（mHSPC）男性患者被随机分配接受雄激素剥夺疗法（ADT）联合或不联合多西他赛治疗，结果显示多西他赛治疗可显著提高患者的总生存期（OS）。
在这项试验的事后分析中，我们使用 Cox 比例风险模型评估了年龄≥70 岁（“老年男性”）与<70 岁（“年轻男性”）患者的特征和 OS。此外，我们使用卡方检验比较了这两组患者的不良事件、治疗完成率和后续治疗模式。
177 名（22.4%）患者年龄≥70 岁。多西他赛+ADT 治疗可显著提高老年和年轻男性的 OS（老年男性 HR 0.45，95%CI：0.25-0.80；年轻男性 HR 0.71，95%CI：0.53-0.95）。这种治疗获益在高肿瘤负荷疾病（HR 0.43，95%CI 0.23-0.79）和初发转移性疾病（HR 0.36，95%CI 0.19-0.69）的老年男性亚组中也得到了证实。完成六周期多西他赛治疗的老年和年轻男性比例相似（分别为 82.6%和 87.1%，p=0.28）。老年和年轻男性的 3-5 级不良事件发生率相似（分别为 36.8%和 26.8%，p=0.069）。老年和年轻男性的任何 4-5 级不良事件发生率差异无统计学意义（分别为 14.9%和 11.9%，p=0.46）。在对照组中，与年轻男性相比，老年男性接受后续癌症治疗（34.4% vs. 51.5%，p=0.017）或后续多西他赛治疗（25.6% vs. 37.6%，p=0.035）的比例较低。
与年轻男性相比，接受多西他赛+ADT 治疗的 mHSPC 老年男性具有相似的 OS 获益和临床结局。肿瘤学家应考虑将多西他赛化疗作为适合化疗的 mHSPC 老年男性的有利治疗选择。
