Systemic Anti-Cancer Therapy (SACT) in elderly patients with urological malignancy


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Dorothy Yang1,Victoria Dunnett-Kane2,Nicholas Williams2,Ursula McGovern3
1Royal Free London NHS Foundation Trust,2UCL Medical School,3Barnet Hospital, Royal Free London NHS Foundation Trust and University College London Hospital

Abstract

Background

Urological malignancy is a common cause of morbidity and mortality in older adults. However, there remains limited evidence to guide treatment decisions. Elderly patients are poorly represented in clinical trials, although they represent a significant proportion of every day clinical practice. Chronological age is often a poor guide when assessing fitness for treatment and elderly patients of good performance status should not be denied treatment based on age. The aim of this study was to assess the outcomes for elderly patients with advanced bladder or prostate cancer who were deemed fit to receive SACT.

Method

We identified patients with a diagnosis of advanced bladder or prostate cancer who commenced chemotherapy or novel hormonal agents when aged ≥80 years old, under the care of a medical oncologist at Barnet Hospital/UCLH between October 2011 to April 2018. We retrospectively collected data on ECOG performance status (PS), response to treatment (either radiological or biochemical), toxicity of treatment, and reasons for cessation of SACT.

Results

30 cases were identified. Mean age was 83.2 years (range 80-91 years). 9 (30%) were PS0, 16 (54%) PS1, 4 (13%) PS2, and 1 (4%) PS3. 20% of patients (n=6) experienced Grade 3 or 4 toxicity from treatment. Only 2 patients (6.7%) stopped treatment due to toxicity. There were no treatment-related deaths. The remaining 80% of patients tolerated treatment well. Biochemical response rates were high in the prostate cancer cohort, with patients exhibiting significant PSA responses to chemotherapy and novel hormonal treatment. In the bladder cancer cohort, most patients had evidence of radiological response to treatment (either stable disease, partial or complete response).

Conclusion

Elderly patients of good performance status tolerate SACT, with evidence of clinical, radiological and biochemical response, and with acceptable toxicity profiles. Older age should not preclude patients from radical systemic treatment options for urological malignancy.