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Pharmacotherapeutic Management of Metastatic, Castration-Resistant Prostate Cancer in the Elderly: Focus on Non-Chemotherapy Agents

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Abstract

In the past 4 years, five new agents have been approved for metastatic, castration-resistant prostate cancer. Four of them are non-chemotherapeutic and generally well tolerated. However, each has toxicities that can negatively impact patients, particularly the elderly. This review covers the epidemiology of prostate cancer in elderly men. It discusses the efficacy data for sipuleucel-T, abiraterone in chemotherapy-naïve patients, enzalutamide in chemotherapy-naïve patients and radium-223 and presents any additional studies done for those over 75 years of age. Disease burden, such as the presence or absence of visceral disease, and comorbid conditions weigh into the selection of therapy and are discussed here. Drug–drug interactions between these agents and other drugs commonly used in the elderly population are also considered. The emerging therapies tasquinimod and ipilimumab are reviewed. With the arrival of so many agents for prostate cancer, selection of the most appropriate agent can be perplexing, particularly because these agents were tested against placebo, not one another. Furthermore, the study population differs significantly from those seen in clinical practice. This review addresses these issues.

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Acknowledgments and Conflict of interest

J.N. Graff (JNG) and T.M. Beer (TMB) have received research funding from Medivation. JNG also received research funding from Sanofi. TMB also received research funding from Janssen, Astellas and Dendreon. TMB received consulting fees from Bayer, Dendreon, Janssen. TMB participated in a certified nursing program that received support from Astellas/Medivation, Bayer and Dendreon. JNG and TMB received an honorarium from Bayer for writing an educational piece. JNG and TMB received money from Bayer to travel to a research-related meeting. No funding was used in the preparation of this manuscript.

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Authors and Affiliations

  1. Portland VA Medical Center, Portland, OR, USA

    Julie N. Graff & Tomasz M. Beer

  2. Knight Cancer Institute, Oregon Health & Science University, 3710 SW US Veterans Hospital Road, P3CHEMO, Portland, OR, 97239, USA

    Julie N. Graff & Tomasz M. Beer

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  1. Julie N. Graff
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Correspondence to Julie N. Graff.

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Graff, J.N., Beer, T.M. Pharmacotherapeutic Management of Metastatic, Castration-Resistant Prostate Cancer in the Elderly: Focus on Non-Chemotherapy Agents. Drugs Aging 31, 873–882 (2014). https://doi.org/10.1007/s40266-014-0224-y

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