Doublet Chemotherapy in the Elderly Patient With Ovarian Cancer

Abstract

After completing this course, the reader will be able to:1. Summarize trends in the treatment of older women with ovarian cancer.2. Describe the potential value of performing a geriatric assessment prior to treatment in older women with ovarian cancer.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe aging of the population has focused on the need to evaluate older patients with cancer. Approximately 50% of patients with ovarian cancer will be older than age 65 years. Increasing age has been associated with decreased survival. It is uncertain whether this relates to biologic factors, treatment factors, or both. There is concern that undertreatment may be associated with decreased survival. Older patients with ovarian cancer have been underrepresented in clinical trials. Therefore, the evidence base on which make decisions is lacking. Clinicians need to be aware of the currently available data to aid in treatment decisions. Doublet therapy is the most common standard treatment in epithelial ovarian cancer. It usually consists of a taxane and a platinum compound. A series of cooperative group studies in both the United States and Europe established intravenous paclitaxel and carboplatin as the most common standard in optimally debulked patients. The recent introduction of intraperitoneal therapy has complicated decision making in terms of which older patients would benefit from this more toxic therapy. In relapsed patients, the issue of platinum sensitivity is critical in deciding whether to reutilize platinum compounds. It is unclear whether single agents or combinations are superior, particularly in older patients. Geriatric assessment is an important component of decision making. Prospective studies are needed to develop strategies to determine the optimal treatment for older patients with ovarian cancer. The Oncologist

Prognostic Factors for Ovarian Epithelial Cancer in the Elderly

“…However, it is worth noting that most published randomized studies evaluating taxanes in this first-line setting included only 10% to 23% of patients older than 70 years. 28 Real impact of taxanes in this population was studied by the French organization GINECO (Groupe d'Investigateurs Nationaux pour l'É tude des Cancers Ovariens) in a retrospective comparison of 2 trials FIGURE 1. Progression-free survival curves according to age.…”

Carboplatin and programmed death‐ligand 1 blockade synergistically produce a similar antitumor effect to carboplatin alone in murine ID8 ovarian cancer model

“…The important function of carboplatin, a novel antitumor agent in OC, was reported in a meta‐analysis of 37 randomized trials in over 5000 patients that showed the superiority of platinum over non‐platinum based chemotherapies . Platinum‐based chemotherapy remains the mainstay of treatment for OC . Immune evasion and immunosuppression is critical in tumorigenesis and development.…”

“…16 Platinum-based chemotherapy remains the mainstay of treatment for OC. 17 Immune evasion and immunosuppression is critical in tumorigenesis and development. The PD-1/ PD-L1 pathway maintains peripheral homeostasis and tolerance by suppressing T cell receptor signaling.…”

Understanding and managing medication in elderly people

“…For example, older women with ovarian cancer have been under-represented in clinical trials [45]. Elderly people may be excluded from trials by design, because of age, comorbidity or polypharmacy, or by default, where functional limitation prevents participation.…”