Metronomic Chemotherapy for Metastatic Prostate Cancer A 'Young' Concept for Old Patients?
Metronomic Chemotherapy for Metastatic Prostate Cancer A 'Young' Concept for Old Patients?
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DOI：
10.2165/11537480-000000000-00000
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发表时间：
2010-01-01
期刊：
影响因子：
2.8
通讯作者：
Bocci, Guido
中科院分区：
文献类型：
--
作者：
Fontana, Andrea;Falcone, Alfredo;Bocci, Guido
前列腺癌是老年人的常见病，随着人口老龄化和筛查率的提高，老年前列腺癌患者的数量可能会增加。在有几种并发症的老年患者中，癌症管理可能很复杂，在这种情况下进行毒性治疗的风险应该仔细评估。节拍化疗，即低剂量、长期、频繁使用的化疗，已被证明对癌症有显著的稳定作用，并对包括前列腺癌在内的患者的生活质量产生积极影响。考虑到节律化疗的低毒性，当标准化疗被禁忌或患者不能接受时，老年患者或合并疾病的患者可能是一线或二线口服节律方法的候选者。此外，患者能够在家中度过更多时间的可能性是节律化疗等姑息治疗的重要组成部分。不幸的是，尽管有这些考虑，关于老年患者节律化疗的活性和安全性的数据很少。然而，在一小部分患者中进行的回溯性分析已经发表，尽管存在局限性，但这些分析表明，新的节律时间表耐受性好、安全，并显示出在患有转移性前列腺癌的老年、“不健康”(表现不佳)患者中潜在的有趣的活动。因此，在老年转移性前列腺癌患者的前瞻性、随机、II/III期临床研究中评估节律化疗策略似乎是有必要的。
Prostate cancer is a common disease in the elderly, and the number of older prostate cancer patients will probably increase with both the aging of the population and the increased rate of screening. In elderly patients with several co-morbidities, cancer management can be complex, and the risk of administering toxic therapy in this setting should be carefully evaluated. Metronomic chemotherapy, i.e. low-dose, long-term, frequently administered chemotherapy, has been shown to have a significant stabilizing effect on cancer and a positive impact on the quality of life of patients, including those with prostate cancer. Given the low toxicity profile of metronomic chemotherapy, elderly patients or patients with co-morbidities may be candidates for a first-line or second-line oral metronomic approach when standard chemotherapies are contraindicated or not acceptable to the patient. Moreover, the possibility of patients being able to spend more time at home is an important component of a palliative treatment such as metronomic chemotherapy. Unfortunately, and despite these considerations, very few data are available on the activity and safety of metronomic chemotherapy in elderly patients. However, retrospective analyses conducted in a small cohort of patients have been published and, notwithstanding their limitations, indicate that novel metronomic schedules are well tolerated, safe and show potentially interesting activity in elderly, 'unfit' (poor performance status) patients with metastatic prostate cancer. Therefore, evaluation of metronomic chemotherapy strategies in prospective, randomized, phase II/III clinical studies of elderly patients with metastatic prostate cancer appears to be warranted.