New study below [1].
I can't recall when the United States Preventive Services Task Force [USPSTF] advised that men who have reached age 70 should not screen for PCa. But knowing that the life expectancy at age 70 is close to 15 years, & that PCa incidence increases with age, I thought it was bad advice. By the time I eventually reached age 70, I began to see the advice as less about wanting to save men who might die within 10 years anyway, from treatment morbidity, & more about ageism. Many men reach age 70 without comorbidities & might do much better than 15 years with curative treatment.
And now we have a French study that uses the magical 70 cutoff.
"Docetaxel {Taxotere} statistically improved PFS {progression-free survival} (HR, 0.51 ...) but not OS {overall survival}"
Similary, Abiraterone {Zytiga} (HR, 0.49) & Celecoxib {Celebrex} (HR, 0.67), but no overall survival.
"Zoledronic acid {Zometa} did not improve PFS or OS".
Recently, there was discussion about a study that reported progression-free survival as proof of benefit. Clinical trials that measure overall survival are much longer & much more expensive.
Improved progression-free survival without an improvement in overall survival, implies either (i) a faster time to PCa death after treatment failure &/or (ii) increased mortality from other causes.
In the case of the latter, it has been argued that it is far better to die of something else, but I am only interested in improved overall survival.
***
A note on age 70 cut-offs:
Pension plans are an early 20th century phenomena. It would be very odd for a company to establish a conventional "defined benefit" plan today. Typically, the "normal retirement age" was set at 65. (70 is presumably the new 65). The plans were sometimes called "superannuation" plans. The word "superannuated" has often been used as an insult. It's Latin root means unfit for work, outmoded, worn out. Indeed, the plans are schemes that pay out on the basis that most will die before or shortly after age 65. The few that survive in good health enjoy the spoils.
To be "over age 70" seems to be short-hand for being on the scrap-heap. Infirm & not long for this world. I don't know what the average age of the USPSTF is. Probably half of mine. Not much hope of outliving them. The best I can hope for is that they all reach age 70. LOL
-Patrick
[1] ncbi.nlm.nih.gov/pubmed/312...
Clin Genitourin Cancer. 2019 May 13. pii: S1558-7673(18)30717-1. doi: 10.1016/j.clgc.2019.05.001. [Epub ahead of print]
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 T1, Guetz GD2, Chouahnia K3, Fossey-Diaz V4, Taleb C5, Culine S6.
Author information
1
Geriatric Oncology Coordination Unit - UCOG, APHP, René Muret Hospital, HUPSSD - Université Paris 13, Sevran, France; Geriatric Department, AP-HP, René Muret Hospital, HUPSSD, Sevran, France. Electronic address: thierry.landre@aphp.fr.
2
Oncology Department, CH Delafontaine, Université de Limoges, St Denis, France.
3
Oncology Department, Avicenne Hospital, HUPSSD - Université Paris 13, Bobigny, France.
4
Geriatric Department, UCOG, AP-HP, Bretonneau Hospital, Paris, France.
5
Geriatric Department, AP-HP, René Muret Hospital, HUPSSD, Sevran, France.
6
Department of Medical Oncology, UCOG, AP-HP, Saint-Louis Hospital, Paris, France; Paris Diderot University, Paris, France.
Abstract
BACKGROUND:
Results from large randomized controlled trials combining docetaxel, abiraterone, celecoxib, or bisphosphonates with androgen deprivation therapy (ADT) in hormone-sensitive prostate cancer have emerged. However, in our knowledge, few data are available in patients older than 70 years. Therefore, we undertook a meta-analysis of all published phase III studies.
MATERIALS AND METHODS:
We performed a PubMed search using the keywords: "hormone sensitive prostate cancer," "phase III studies," "docetaxel," "abiraterone," "celecoxib," and "bisphosphonates." We also screened American Society of Clinical Oncology and European Society for Medical Oncology proceedings. Combination therapies were compared with ADT alone. The efficacy outcomes were overall survival (OS) and progression-free survival (PFS). Hazard ratios (HRs) with their 95% confidence intervals (CIs) were collected from the studies and pooled. A hazard ratio of less than 1.00 favored the combination group.
RESULTS:
This meta-analysis included 8 studies: 3 assessed docetaxel (CHAARTED, STAMPEDE arm E and C), 2 others assessed abiraterone (LATITUDE and STAMPEDE arm G); 2 others assessed celecoxib (STAMPEDE arm D and F), and the last one assessed zoledronic acid alone (STAMPEDE arm B). Our meta-analysis included 2264 patients (86% with metastases). Concerning age, we chose a cutoff of 70 years, corresponding to the available data for each study. The performance index was 0 to 1 for about 90% of patients. Overall, in patients > 70 years old, the addition of docetaxel statistically improved PFS (HR, 0.51; 95% CI, 0.42-0.61) but not OS (HR, 0.86; 95% CI, 0.69-1.07). The addition of abiraterone to ADT also statistically improved PFS (HR, 0.49; 95% CI, 0.37-0.64) but not OS (HR, 0.85; 95% CI, 0.67-1.08), as well as the addition of celecoxib (HR, 0.67; 95% CI, 0.53-0.85 and HR, 0.95; 95% CI, 0.73-1.25, respectively). The addition of zoledronic acid did not improve PFS or OS (HR, 0.78; 95% CI, 0.61-1.00 and HR, 0.99; 95% CI, 0.71-1.38, respectively).
CONCLUSIONS:
The addition of docetaxel, abiraterone, or celecoxib to ADT significantly increased PFS in older men with hormone-sensitive advanced prostate cancer. However, the benefit in OS is not statistically significant. Further studies are needed to define the best first-line strategy in this subgroup.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Abiraterone; Docetaxel; Elderly; First-line; Metastatic prostate cancer
PMID: 31227430 DOI: 10.1016/j.clgc.2019.05.001
