Effectiveness and safety of standard chemotherapy in older patients with ovarian cancer: a retrospective analysis by age group and treatment regimen

Miriam R Brezis; Eliya Shachar; Shira Peleg Hasson; Ido Laskov; Nadav Michaan; Bar Levy; Ido Wolf; Tamar Safra

doi:10.3389/fonc.2023.1289379

Effectiveness and safety of standard chemotherapy in older patients with ovarian cancer: a retrospective analysis by age group and treatment regimen

Front Oncol. 2023 Dec 13:13:1289379. doi: 10.3389/fonc.2023.1289379. eCollection 2023.

Authors

Miriam R Brezis¹, Eliya Shachar^{1

2}, Shira Peleg Hasson^{1

2}, Ido Laskov^{1

2}, Nadav Michaan^{1

2}, Bar Levy¹, Ido Wolf^{1

2}, Tamar Safra^{1

2}

Affiliations

¹ Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
² Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Abstract

Objective: To evaluate the effectiveness and safety of standard chemotherapy administered to patients >70 years with advanced ovarian cancer (OC).

Methods: Medical records of 956 advanced-stage patients with OC treated between 2002-2020 with standard surgery and paclitaxel-carboplatin chemotherapy in a three-weekly (PC-3W) or weekly (PC-1W) regimen were reviewed. Treatment response and tolerability were compared between patients ≤70 years (N=723) and >70 years (N=233) with stratification to septuagenarians (>70-80 years) and octogenarians (>80 years).

Results: Median overall survival (mOS) in patients >70 was 41.26 months (95% confidence interval [Cl], 37.22-45.14) and median progression-free survival (mPFS) was 11.04 months (95% Cl, 8.97-15.74). No statistically significant differences in mPFS and mOS were observed between septuagenarians and octogenarians. Patients >70 treated with PC-1W versus PC-3W had significantly longer mOS (57.17 versus 30.00 months) and mPFS (19.09 versus 8.15 months). Toxicity rates were mostly similar between younger and older patients. Among patients >70 treated with PC-1W, the rate of neutropenia (75.7% versus 51.8%, p=0.0005), thrombocytopenia (41.0% versus 22.2%, p=0.0042) and anemia (78.1% versus 51.9%, p<0.0001) were significantly higher and the rate of grade 2 alopecia was statistically significantly lower compared with those >70 treated with PC-3W. Significantly more patients treated with PC-1W completed ≥6 chemotherapy cycles, suggesting better tolerability of this regimen.

Conclusions: Older patients with OC may benefit from improved OS with reasonable toxicity if treated with standard chemotherapy. Older patients treated with PC-1W are more likely to complete the full chemotherapy course and survive longer compared with those treated with conventional PC-3W.

Keywords: chemotherapy; neoadjuvant chemotherapy; older patients; ovarian cancer; survival; tolerability; toxicity.

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.