Abstract
Objective
Advancing age is a risk factor for survival in ovarian cancer. Gynecologic Oncology
Group protocol 172 showed survival advantages and higher toxicity with intraperitoneal
(IP) chemotherapy in women with optimally debulked, stage III ovarian cancer. Our
objective was to explore the tolerance of IP therapy in older patients.
Methods
We performed a descriptive analysis of ovarian cancer patients aged 65 years or older who had an IP catheter placed for either first-line IP chemotherapy
or consolidation following intravenous (IV) carboplatin/paclitaxel. An intention-to-treat
analysis of 100 ovarian cancer patients younger than 65 years was performed for comparison.
Results
Between 1994 and 2008, 100 patients ≥65 years of age had an IP catheter inserted at our institution. Median age was 70 (range,
65–83). Median Karnofsky performance status was 90% (range, 70–90), and median number
of comorbidities was 2 (range, 0–6). Twenty-four patients had first-line IP/IV cisplatin-paclitaxel,
and 76 had IP cisplatin consolidation after completion of IV treatment. In the IP/IV
cohort, 13 women (54%) completed all 6 planned cycles of IP therapy; 18 (75%) completed
at least 4 cycles. Of all 100 patients, 13 had treatment delays, and 37 required dose
reductions (21% at baseline). Median number of IP cycles was 3 (range, 0–6). There
was no significant difference in the number of grade ≥3 toxicities between younger and older patients.
Conclusions
IP chemotherapy can be safely administered in selected older patients with adequate
support and dose modifications either as first-line treatment or as a consolidation
therapy. Efforts to include older patients in future prospective trials should be
emphasized.
Keywords
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References
- Advanced ovarian cancer in the elderly: results of consecutive trials with cisplatin-based chemotherapy.Crit Rev Oncol Hematol. 2001; 37: 27-34
- Cancer statistics, 2010.CA Cancer J Clin. 2010; 60: 277-300
- Ovarian cancer. Survival and treatment differences by age.Cancer. 1993; 71: 524-529
- Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group experience.Cancer. 1993; 71: 606-614
- Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study.J Clin Oncol. 2007; 25: 3621-3627
- FIGO stage, histology, histologic grade, age and race as prognostic factors in determining survival for cancers of the female gynecological system: an analysis of 1973–87 SEER cases of cancers of the endometrium, cervix, ovary, vulva, and vagina.Semin Surg Oncol. 1994; 10: 31-46
- Age contrasts in patients with advanced epithelial ovarian cancer. The M.D. Anderson Cancer Center experience.Cancer. 1993; 71: 638-643
- An assessment of age and other factors influencing protocol versus alternative treatments for patients with epithelial ovarian cancer referred to member institutions: a Gynecologic Oncology Group study.Gynecol Oncol. 2004; 94: 368-374
- Treatment patterns by decade of life in elderly women (> or =70 years of age) with ovarian cancer.Gynecol Oncol. 2005; 98: 403-408
- Variations in the use of chemotherapy for elderly patients with advanced ovarian cancer: a population-based study.J Clin Oncol. 2002; 20: 173-178
- Treatment of ovarian cancer in elderly women. Mayo Clinic-North Central Cancer Treatment Group studies.Cancer. 1993; 71: 615-617
- Age does not influence taxol dose intensity in recurrent carcinoma of the ovary.Cancer. 1993; 71: 594-600
- Response and outcomes in elderly patients with stages IIIC-IV ovarian cancer receiving platinum–taxane chemotherapy.Gynecol Oncol. 2007; 106: 381-387
- The effect of age on the tolerability of intraperitoneal chemotherapy, complication rate, and survival in patients with ovarian cancer.Gynecol Oncol. 2010; 119: 491-495
- Ovarian cancer in the elderly.Crit Rev Oncol Hematol. 2004; 49: 77-86
- Phase II prospective study of paclitaxel and carboplatin in older patients with newly diagnosed Mullerian tumors.Gynecol Oncol. 2009; 112: 394-399
- Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study.J Clin Oncol. 2002; 20: 494-502
- Intraperitoneal cisplatin and paclitaxel in ovarian cancer.N Engl J Med. 2006; 354: 34-43
- Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer.N Engl J Med. 1996; 335: 1950-1955
- Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group.J Clin Oncol. 2001; 19: 1001-1007
- NCI Clinical Announcement: Intraperitoneal chemotherapy for ovarian cancer.(Available at:)http://www.gog.org/IPChemoEd/clinicalann.pdf(Last accessed: November 9, 2011.)Date: January 5, 2006
- Toxicities of modified outpatient regimen of IV/Ip Paclitaxel and Ip Cisplatin in women with newly diagnosed ovarian cancer: 0123.Int J Gynecol Cancer. 2006; 16: 635
- CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment.Semin Radiat Oncol. 2003; 13: 176-181
- Do elderly cancer patients care about cure? Attitudes to radical gynecologic oncology surgery in the elderly.Gynecol Oncol. 2001; 81: 447-455
- Age contrasts in clinical characteristics and pattern of care in patients with epithelial ovarian cancer.Gynecol Oncol. 2002; 86: 274-278
- Effect of creatinine clearance on patterns of toxicity in older patients receiving adjuvant chemotherapy for breast cancer.Drugs Aging. 2005; 22: 785-791
- Greater risks of chemotherapy toxicity in elderly patients with cancer.J Support Oncol. 2003; 1: 18-24
- Management of cancer in the older person: a practical approach.Oncologist. 2000; 5: 224-237
- Predicting chemotherapy toxicity in older adults with cancer: a prospective 500 patient multicenter study.J Clin Oncol. 2010; 28 (Meeting Abstracts): 9001
- A brief clinical instrument to classify frailty in elderly people.Lancet. 1999; 353: 205-206
- Comorbidity and functional status are independent in older cancer patients.J Clin Oncol. 1998; 16: 1582-1587
Article info
Publication history
Published online: March 14, 2012
Accepted:
February 10,
2012
Received in revised form:
January 23,
2012
Received:
November 9,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
