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The Effect of Age on First-line Chemotherapy for Epithelial Ovarian Cancer and Primary Peritoneal Carcinoma
Letters / Clinical Oncology 25 (2013) 74e75
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The Effect of Age on First-line Chemotherapy for Epithelial Ovarian Cancer and Primary Peritoneal Carcinoma Sir d Of the 6500 women in the UK diagnosed with ovarian cancer every year, about one-third are 75 years old [1]. The optimal treatment for this type of malignancy is a combination of surgery and chemotherapy. The aim of surgical resection is to reduce the residual tumour bulk as the volume of residual disease determines the prognosis [2,3]. In the elderly, postoperative morbidity may be significant enough to outweigh the benefits of the surgical process and the decision regarding adjuvant treatment is often complex. We analysed the toxicity profile and outcome for a cohort of elderly patients with epithelial ovarian cancer and primary peritoneal carcinoma, receiving first-line chemotherapy treatment with carboplatin and paclitaxel or single-agent carboplatin. We identified 81 elderly patients (75 years old) who had a histological diagnosis of epithelial ovarian or primary peritoneal cancer and were 75 years old. Most patients had serous cancer (77.8%) and 59% presented at FIGO stage 3c with 22.2% at FIGO stage 4. cytoreductive surgery (CRS) was carried out in 54 of the 81 elderly patients and 63.0% (34/54) had optimal surgery. Chemotherapy feasibility was defined as the ability to receive six cycles of chemotherapy without disease progression or grade 3/4 toxicity. Twenty-three of 64 patients received carboplatin and paclitaxel and 41/64 received carboplatin alone. The chemotherapy feasibility was 93% in the carboplatin and paclitaxel arm and 79.6% in the carboplatin arm. The most common toxicity was peripheral neuropathy (56.5% in the carboplatin and paclitaxel arm) and the main reason for deferral was haematological toxicity. The estimated median survival for
this group of patients was 21.3 months. The median progression-free survival was 8.8 months in the carboplatin and paclitaxel arm and 7 months in the carboplatin arm. We conclude that the toxicity of the combination treatment with carboplatin and paclitaxel was comparable with single-agent carboplatin in the elderly population with frequent dose delays and dose reductions. Effort should be made to offer patients optimal treatment with the combination regimen with a careful initial assessment of comorbidities and performance status. E. Larbi*, K. Madhuri*, S. Essapen*, S. Butler-Manuel*, A. Tailor*, A. Michaely *St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford, UK yPostgraduate Medical School, Oncology, University of Surrey, Guildford, UK
References [1] Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002;20(5):1248e1259. [2] CRUK http://info.cancerresearchuk.org/cancerstats/types/ovary/ incidence/. [3] Wimberger P, Lehmann N, Kimmig R, et al. Impact of age on outcome in patients with advanced ovarian cancer treated within a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol 2006;100(2): 300e307.
Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved http://dx.doi.org/10.1016/j.clon.2012.09.007
75
The Effect of Age on First-line Chemotherapy for Epithelial Ovarian Cancer and Primary Peritoneal Carcinoma Sir d Of the 6500 women in the UK diagnosed with ovarian cancer every year, about one-third are 75 years old [1]. The optimal treatment for this type of malignancy is a combination of surgery and chemotherapy. The aim of surgical resection is to reduce the residual tumour bulk as the volume of residual disease determines the prognosis [2,3]. In the elderly, postoperative morbidity may be significant enough to outweigh the benefits of the surgical process and the decision regarding adjuvant treatment is often complex. We analysed the toxicity profile and outcome for a cohort of elderly patients with epithelial ovarian cancer and primary peritoneal carcinoma, receiving first-line chemotherapy treatment with carboplatin and paclitaxel or single-agent carboplatin. We identified 81 elderly patients (75 years old) who had a histological diagnosis of epithelial ovarian or primary peritoneal cancer and were 75 years old. Most patients had serous cancer (77.8%) and 59% presented at FIGO stage 3c with 22.2% at FIGO stage 4. cytoreductive surgery (CRS) was carried out in 54 of the 81 elderly patients and 63.0% (34/54) had optimal surgery. Chemotherapy feasibility was defined as the ability to receive six cycles of chemotherapy without disease progression or grade 3/4 toxicity. Twenty-three of 64 patients received carboplatin and paclitaxel and 41/64 received carboplatin alone. The chemotherapy feasibility was 93% in the carboplatin and paclitaxel arm and 79.6% in the carboplatin arm. The most common toxicity was peripheral neuropathy (56.5% in the carboplatin and paclitaxel arm) and the main reason for deferral was haematological toxicity. The estimated median survival for
this group of patients was 21.3 months. The median progression-free survival was 8.8 months in the carboplatin and paclitaxel arm and 7 months in the carboplatin arm. We conclude that the toxicity of the combination treatment with carboplatin and paclitaxel was comparable with single-agent carboplatin in the elderly population with frequent dose delays and dose reductions. Effort should be made to offer patients optimal treatment with the combination regimen with a careful initial assessment of comorbidities and performance status. E. Larbi*, K. Madhuri*, S. Essapen*, S. Butler-Manuel*, A. Tailor*, A. Michaely *St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford, UK yPostgraduate Medical School, Oncology, University of Surrey, Guildford, UK
References [1] Bristow RE, Tomacruz RS, Armstrong DK, et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002;20(5):1248e1259. [2] CRUK http://info.cancerresearchuk.org/cancerstats/types/ovary/ incidence/. [3] Wimberger P, Lehmann N, Kimmig R, et al. Impact of age on outcome in patients with advanced ovarian cancer treated within a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol 2006;100(2): 300e307.
Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved http://dx.doi.org/10.1016/j.clon.2012.09.007