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Systemtherapie des Prostatakarzinoms im hohen Alter

Systemic therapy of prostate cancer in elderly patients

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Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Die meisten Prostatakarzinome (PCa) werden jenseits des 65. Lebensjahrs diagnostiziert. Dennoch ist die Zahl der älteren, gebrechlichen Männer in klinischen Studien zum fortgeschrittenen PCa häufig unterrepräsentiert.

Material und Methoden

Die Erstellung des narrativen Reviews erfolgte basierend auf einer Literaturrecherche in PubMed (MEDLINE) sowie den Abstract-Datenbanken der American Society of Medical Oncology (ASCO) und der European Society for Medical Oncology (ESMO). Ein Fokus lag dabei auf der Praxisrelevanz der Daten für den Behandlungsalltag.

Ergebnisse

In den randomisierten Phase-III-Studien zeigte sich eine häufig vergleichbare Effektivität der experimentellen Therapien bei den älteren Patienten im Vergleich zur Gesamtpopulation, allerdings nicht selten um den Preis einer erhöhten Toxizität. Screening-Instrumente zur Einschätzung der Gebrechlichkeit wie der G8 können helfen, die Therapiefähigkeit der älteren Patienten besser einzuschätzen. Komorbiditäten und Polypharmazie stellen eine Herausforderung im Behandlungsalltag dar und müssen bei der Therapiewahl beachtet werden. Während den fitten älteren Patienten eine Standardtherapie allein aufgrund des kalendarischen Alters nicht verwehrt werden sollte, muss bei den gebrechlichen Patienten überprüft werden, ob eine gezielte geriatrische Intervention die Therapiefähigkeit verbessern kann. Bei Betroffenen mit schweren Einschränkungen muss die Behandlung entsprechend angepasst werden.

Schlussfolgerung

Bislang richten sich nur wenige Studien gezielt an ältere und gebrechliche PCa-Patienten. Screening-Instrumente werden im Behandlungsalltag nur selten eingesetzt. Hier ist dringlich ein Umdenken erforderlich, um den Patienten besser gerecht zu werden, insbesondere vor dem Hintergrund einer stetig alternden Bevölkerung.

Abstract

Background

The vast majority of prostate cancer (PCa) patients are diagnosed beyond the age of 65. However, older, frail patients are often underrepresented in clinical trials of advanced PCa.

Materials and methods

This narrative review was prepared based on a literature search of PubMed (MEDLINE) and the American Society of Medical Oncology (ASCO) and European Society for Medical Oncology (ESMO) abstract databases, with a focus on the practical relevance of the data for everyday treatment.

Results

Randomized phase III trials in advanced PCa have often showed comparable efficacy of experimental treatments in elderly patients compared to the overall population, although not infrequently at the cost of increased toxicity. Screening tools to assess frailty, such as the G8, may help to better assess the ability of elderly patients to receive systemic therapy. Comorbidities and polypharmacy pose a challenge in everyday treatment and must be considered when choosing therapy. While fit elderly patients should not be denied standard treatment based on their calendrical age alone, frail patients need to be assessed to determine whether targeted geriatric intervention can improve their ability to undergo therapy. In men with severe limitations, treatment must be adjusted accordingly.

Conclusion

To date, few studies have specifically targeted elderly and frail PCa patients. Screening tools are rarely used in everyday treatment. A change of mindset is urgently needed here to better serve our patients, especially in the context of a steadily aging population.

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Author information

Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik (Onkologie, Hämatologie, Knochenmarktransplantation mit Abteilung für Pneumologie), Zentrum für Onkologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Gunhild v. Amsberg, Tobias Busenbender & Carsten Bokemeyer

  2. Martini-Klinik, Prostate Cancer Center, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Gunhild v. Amsberg & Derya Tilki

  3. Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Derya Tilki

Authors
  1. Gunhild v. Amsberg
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  2. Tobias Busenbender
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  4. Carsten Bokemeyer
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Corresponding author

Correspondence to Gunhild v. Amsberg.

Ethics declarations

Interessenkonflikt

G. v. Amsberg macht folgende Angaben: Beratungs- bzw. Gutachtertätigkeit, Advisory Boards: Roche, BMS, Astellas, Sanofi, Janssen, MSD, Merck, Pfizer, Bayer, Amgen, EISAI, Novartis, Lilly, Astra Zeneca, Ipsen; Honorare/Vorträge/Reisekosten/ Kongressunterstützung: Roche, BMS, Astellas, Janssen, MSD, Merck, Pfizer, Bayer, Amgen, EISAI, Astra Zeneca, Ipsen; Finanzierung wissenschaftlicher Untersuchungen im Rahmen Industrie-gesponserter Studien: Roche, BMS, MSD, Astra Zeneca, Sanofi, Lilly, EISAI, Amgen, AvenCell, Ipsen. T. Busenbender: keine. D. Tilki: Speaker honoria: Apogepha, AstraZeneca, Elekta, Exact Sciences, Ipsen, Janssen, Novartis, Pfizer, Takeda. Consulting or Advisory Role: A3P Biomedical, AstraZeneca, Roch. C. Bokemeyer: AOK Germany, Invited Speaker, Personal Astra Zeneca, Advisory Board, Personal Bayer Healthcare, Advisory Board, Personal BioNTech, Advisory Board, Personal Bristol Myers Squipp, Advisory Board, Personal, and lectures given Jansen Cilag, Advisory Board, Personal med update, Invited Speaker, Personal, orgaistion for medical education Merck Serono, Advisory Board, Personal, advisory boards and speaker Oncology Drug Consult CRO, Advisory Board, Personal Roche Pharma, Invited Speaker, Personal Sanofi Aventis, Advisory Board, Personal, Boards attended and lectures given more than 95 clinical trials, Local PI, Institutional, No financial interest, our department is involved in several clincal trials sponsored by industry and cooperative groups where we hold praticipants roles and local PI roles and PI roles. Non-Financial Interests: DGHO, Member of Board of Directors Hamburg Cancer Society, Leadership Role National Network of German Cancer Centers (DKH), Leadership Role Northern German Society of Internal Medicine, Member of Board of Directors DGHO, Advisory Role, Board of DGHO Advisors.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

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v. Amsberg, G., Busenbender, T., Tilki, D. et al. Systemtherapie des Prostatakarzinoms im hohen Alter. Onkologie 30, 119–128 (2024). https://doi.org/10.1007/s00761-023-01453-3

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