Management of metastatic prostate cancer in the elderly: identifying fitness for chemotherapy in the post‐<scp>STAMPEDE</scp> world

Thompson, A.; Sarmah, Piyush; Beresford, Mark; Jefferies, Edward

doi:10.1111/bju.13990

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…AEs grades 3 or 4 were common with docetaxel, mostly as a result of hematologic toxicities (18). The risk of toxic death was significantly increased in older patients, which might be expected given the possibility of lessfit patients, decreased overall life expectancy and inability to tolerate aggressive chemotherapy regimens (19,20) (21).…”

Section: Discussionmentioning

confidence: 99%

Is There a Benefit of Addition Docetaxel, Abiraterone, Celecoxib, or Zoledronic Acid in Initial Treatments for Patients Older Than 70 Years With Hormone-sensitive Advanced Prostate Cancer? A Meta-analysis

Landre

Guetz

Chouahnia

et al. 2019

Clinical Genitourinary Cancer

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Section: Discussionmentioning

confidence: 99%

Is There a Benefit of Addition Docetaxel, Abiraterone, Celecoxib, or Zoledronic Acid in Initial Treatments for Patients Older Than 70 Years With Hormone-sensitive Advanced Prostate Cancer? A Meta-analysis

Landre

Guetz

Chouahnia

et al. 2019

Clinical Genitourinary Cancer

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“…Of note, the STAMPEDE trial of docetaxel in mHSPC only included patients fit for chemotherapy and without significant cardiovascular history. Many patients with mPCa in the real-world are elderly with many comorbidities, and they cannot receive chemotherapy [ 10 ]. In addition, patients with poor general conditions or poor performance status are often not suitable for aggressive anticancer therapies.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Characteristics and Survival in Patients with De Novo Metastatic Prostate Cancer

Cattrini

Soldato

Rubagotti

et al. 2020

Cancers

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The real-world outcomes of patients with metastatic prostate cancer (mPCa) are largely unexplored. We investigated the trends in overall survival (OS) and cancer-specific survival (CSS) in patients with de novo mPCa according to distinct time periods. The U.S. Surveillance, Epidemiology, and End Results (SEER) Research Data (2000–2017) were analyzed using the SEER*Stat software. The Kaplan–Meier method and Cox regression were used. Patients with de novo mPCa were allocated to three cohorts based on the year of diagnosis: A (2000–2003), B (2004–2010), and C (2011–2014). The maximum follow-up was fixed to 5 years. Overall, 26,434 patients were included. Age, race, and metastatic stage (M1) significantly affected OS and CSS. After adjustment for age and race, patients in Cohort C showed a 9% reduced risk of death (hazard ratio (HR): 0.91 (95% confidence interval [CI] 0.87–0.95), p < 0.001) and an 8% reduced risk of cancer-specific death (HR: 0.92 (95% CI 0.88–0.96), p < 0.001) compared with those in Cohort A. After adjustment for age, race, and metastatic stage, patients in Cohort C showed an improvement in OS and CSS compared with Cohort B (HR: 0.94 (95% CI 0.91–0.97), p = 0.001; HR: 0.89 (95% CI 0.85–0.92), p < 0.001). Patients with M1c disease had a more pronounced improvement in OS and CSS compared with the other stages. No differences were found between Cohorts B and C. In conclusion, the real-world survival of de novo mPCa remains poor, with a median OS and CSS improvement of only 4 months in the latest years.

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“…In clinical trials, even if there is no age limit, people are required to be “fit for treatment” as drug tolerance may decrease and toxicity may increase in those with poor fitness [9]. For example, in the STAMPEDE prostate cancer trial, only men without a history of significant cardiovascular disease were recruited, reducing the number of older men in the study [10]. Comorbidities can therefore be a significant barrier to clinical trial entry [3].…”

Section: Introductionmentioning

confidence: 99%

The Siconolfi step test: a valid and reliable assessment of cardiopulmonary fitness in older men with prostate cancer

Lemańska

Poole

Aning

et al. 2019

Eur Rev Aging Phys Act

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BackgroundAssessing fitness and promoting regular physical activity can improve health outcomes and early recovery in prostate cancer. This is however, underutilised in clinical practice. The cardiopulmonary exercise test (CPET) is increasingly being used pre-treatment to measure aerobic capacity and peak oxygen consumption (VO2peak - a gold standard in cardiopulmonary fitness assessment). However, CPET requires expensive equipment and may not always be appropriate. The Siconolfi step test (SST) is simpler and cheaper, and could provide an alternative.The aim of this study was to evaluate the validity and reliability of SST for predicting cardiopulmonary fitness in men with prostate cancer. Men were recruited to this two-centre study (Surrey and Newcastle, United Kingdom) after treatment for locally advanced prostate cancer. They had one or more of three risk factors: elevated blood pressure, overweight (BMI > 25), or androgen deprivation therapy (ADT). Cardiopulmonary fitness was measured using SST and cycle ergometry CPET, at two visits three months apart. The validity of SST was assessed by comparing it to CPET. The VO2peak predicted from SST was compared to the VO2peak directly measured with CPET. The reliability of SST was assessed by comparing repeated measures. Bland-Altman analysis was used to derive limits of agreement in validity and reliability analysis.ResultsSixty-six men provided data for both SST and CPET. These data were used for validity analysis. 56 men provided SST data on both visits. These data were used for reliability analysis. SST provided valid prediction of the cardiopulmonary fitness in men > 60 years old. The average difference between CPET and SST was 0.64 ml/kg/min with non-significant positive bias towards CPET (P = 0.217). Bland-Altman 95% limits of agreement of SST with CPET were ± 7.62 ml/kg/min. SST was reliable across the whole age range. Predicted VO2peak was on average 0.53 ml/kg/min higher at Visit 2 than at Visit 1 (P = 0.181). Bland-Altman 95% limits of agreement between repeated SST measures were ± 5.84 ml/kg/min.ConclusionsSST provides a valid and reliable alternative to CPET for the assessment of cardiopulmonary fitness in older men with prostate cancer. Caution is advised when assessing men 60 years old or younger because the VO2peak predicted with SST was significantly lower than that measured with CPET.

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Management of metastatic prostate cancer in the elderly: identifying fitness for chemotherapy in the post‐STAMPEDE world

Cited by 7 publications

References 7 publications

Is There a Benefit of Addition Docetaxel, Abiraterone, Celecoxib, or Zoledronic Acid in Initial Treatments for Patients Older Than 70 Years With Hormone-sensitive Advanced Prostate Cancer? A Meta-analysis

Is There a Benefit of Addition Docetaxel, Abiraterone, Celecoxib, or Zoledronic Acid in Initial Treatments for Patients Older Than 70 Years With Hormone-sensitive Advanced Prostate Cancer? A Meta-analysis

Epidemiological Characteristics and Survival in Patients with De Novo Metastatic Prostate Cancer

The Siconolfi step test: a valid and reliable assessment of cardiopulmonary fitness in older men with prostate cancer

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