Geriatrisches Assessment – Was sollte vor Therapiebeginn des mHSPC und des mCRPC gemacht und bedacht werden?

Zusammenfassung

Bei der medikamentösen Therapie des Prostatakarzinoms stehen zunehmend Kombinationstherapien im Vordergrund. Für ältere und vorerkrankte Patienten sollten einige Aspekte bei der Therapieauswahl und -durchführung beachtet werden, um Toxizitäten zu vermeiden und sowohl Behandlungserfolg als auch Lebensqualität zu gewährleisten. Zur Definition von geriatrischen Patienten sind nicht in erster Linie das chronologische Alter, sondern vor allem der ganzheitliche Gesundheitszustand und die Lebenserwartung entscheidend. Vorerkrankte Patienten > 70 Jahre sollten vor Therapieeinleitung ein dreischrittiges geriatrisches Screening durchlaufen. Bei Auffälligkeiten im G8-Screening-Fragebogen und/oder mini-COG (berücksichtigt werden die Aspekte Nutrition, Komorbidität/-medikation, Mobilität und Kognition) wird ein vereinfachtes geriatrisches Assessment empfohlen. Es erfolgt eine Risikostratifizierung der Patienten in 3 Gruppen (fit, vulnerabel, gebrechlich). Nur in Einzelfällen ist ein komplettes geriatrisches Assessment erforderlich. Behandelbare Defizite in den genannten Bereichen sollten nach Möglichkeit verbessert werden. Bei der Auswahl der Systemtherapie können fitte Patienten analog zu nicht-geriatrischen Patienten behandelt werden. Vulnerable und gebrechliche Patienten haben in der Regel ein höheres Risiko für Toxizitäten, sodass hier besondere Vorsicht geboten ist. Während die verschiedenen Substanzen der Hormontherapie in der Regel gut vertragen werden (wobei einige wirkstoffspezifische Toxizitäten häufiger auftreten können), bestehen bei hämatotoxischen Substanzen wie Taxanen oder Olaparib Empfehlungen zum eingeschränkten Einsatz. Da Sturzereignisse – insbesondere unter Hormontherapie – ein häufiges Problem darstellen, sollte die Osteoprotektion besonders berücksichtigt werden. Bei Fortschreiten der Tumorerkrankung sollte nicht reflexhaft eine Umstellung der Systemtherapie erfolgen, sondern zusammen mit dem Patienten und seinen Angehörigen ein individuelles Konzept unter Berücksichtigung von palliativmedizinischen und Versorgungsaspekten erstellt werden, das die Lebensqualität in den Mittelpunkt stellt und auch Therapielimitationen festlegt.

Abstract

The systemic treatment of prostate cancer nowadays is predominantly carried out with combination therapies. A range of aspects should be respected in older and comorbid patients, in order to avoid toxicities and to achieve a successful therapy alongside good quality of life. The definition of geriatric patients is not primarily based on chronological age but rather on the overall health condition and life expectancy. Comorbid patients > 70 years should undergo a three-step geriatric screening before treatment initiation. If the G8 screening and/or mini-COG shows abnormalities (taking into account nutrition, comorbidity/medication, mobility, and cognition), a simplified geriatric assessment is recommended. Patients can then be stratified into three groups (fit, vulnerable, frail). Only a few cases warrant a complete geriatric assessment. Treatable deficits in the above mentioned domains should be improved if possible. When choosing a systemic therapy, fit patients can be treated the same as non-geriatric patients. Vulnerable and frail patients are under a higher risk for toxicities, so special care should be taken. While the diverse substances of hormonal therapy are usually well tolerated (even though some substance-specific toxicities can occur), haematotoxic substances such as taxanes or olaparib can only be recommended in select cases. As falls – especially under hormonal therapy – are a common problem, osteoprotective therapy should especially be considered. Upon progression of the tumour disease, there should not be a reflex to simply switch to the next line of treatment, but an individual concept should be established together with the patient and his relatives, taking into account aspects of palliative care and patient needs and focussing on quality of life and also setting therapy limitations.

Schlüsselwörter

Prostatakarzinom - Geriatrie - Hormontherapie - Chemotherapie - personalisierte Medizin

Keywords

prostate cancer - geriatrics - hormonal therapy - chemotherapy - personalised medicine

Publication History

Received: 28 July 2023

Accepted: 14 August 2023

Article published online:
25 September 2023

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