Targeting the androgenic pathway in elderly patients with castration-resistant prostate cancer: A meta-analysis of randomized trials.

The novel hormonal drugs have recently entered in the armamentarium of therapies for treatment of metastatic castration-resistant prostate cancer (CRPC). First reports are available for their use in elderly men with CRPC.

A meta-analysis of randomized controlled trials (RCTs) has been performed. PubMed, the Cochrane Library, and American Society of Clinical Oncology (ASCO) University Meeting were searched for data on the use of new hormonal treatment in elderly patients with CRPC.

Nine studies for a total of 3512 elderly patients were available for meta-analysis. Six studies reported outcomes of patients aged >75 years old while 2 studies reported on patients aged >70 years old. The pooled analysis of the androgen synthesis inhibitors revealed significantly increased overall survival (OS) due to antiandrogen agents compared with placebo or placebo and prednisone (hazard ratio (HR) for death: HR = 0.74, 95% CI: 0.67-0.82; P < 0.00001). Moreover, the new antiandrogenic therapy significantly improved the progression-free survival (HR = 0.45, 95% CI: 0.31-0.65; P < 0.0001). The incidence of any grade ≥3 adverse effect was only moderately higher during with the antiandrogenic therapy as compared to the control arms (response rate = 1.03, 95% CI: 0.88-1.20; P = 0.72).

This study confirmed that agents targeting the androgen axis (i.e., enzalutamide, abiraterone) significantly prolonged OS in elderly men with CRPC.

Medicine. 2016 Oct [Epub]

Giandomenico Roviello, Maria Rosa Cappelletti, Laura Zanotti, Angela Gobbi, Chiara Senti, Alberto Bottini, Andrea Ravelli, Alberto Bonetta, Giovanni Paganini, Daniele Generali

aSection of Pharmacology and University Center DIFF-Drug Innovation Forward Future, Department of Molecular and Translational Medicine, University of Brescia, Brescia bU.S. Terapia Molecolare e Farmacogenomica cRadiotherapy Department, ASST Cremona, Cremona dSection of Experimental Oncology, Department of Clinical and Experimental Medicine, University of Parma, Parma eUnit of General Medicine, Azienda Ospedaliera "C. Poma" Presidio Ospedaliero di Pieve di Coriano, Mantova fDepartment of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy.