Response and outcomes in elderly patients with stages IIIC-IV ovarian cancer receiving platinum-taxane chemotherapy

Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, United States
Gynecologic Oncology (Impact Factor: 3.77). 09/2007; 106(2):381-7. DOI: 10.1016/j.ygyno.2007.04.012
Source: PubMed


Recent reports have suggested that only half of women age > or =65 with advanced ovarian cancer are treated with platinum-based chemotherapy. The objective of this study was to compare the response to platinum-taxane chemotherapy and subsequent outcomes between patients older and younger than 65 years of age with stages IIIC-IV epithelial ovarian cancer (EOC).
A cohort study was performed of all patients with stages IIIC-IV EOC who had their primary surgery at our institution from 1998 to 2004 and subsequently began platinum-taxane chemotherapy. Main outcomes were response to primary chemotherapy, platinum resistance and progression-free (PFS) and overall survival (OS).
A total of 292 patients began primary platinum-taxane therapy after surgery and comprised our study group. Of these, 108 (37%) were > or =65 years old and 184 (63%) were <65. Stage of disease, optimal cytoreduction rate, number of chemotherapy cycles and chemotherapy regimen alterations were similar between groups. Patients > or =65 achieved a clinical complete response with a similar frequency to those <65 (70% vs. 79%) and had similar rates of platinum sensitivity at 6 months (61% vs. 65%). Patients > or =65 had equivalent PFS (P=0.99) and OS (P=0.36) to those <65. Age > or =65 years was not independently associated with impaired survival.
Patients > or =65 years of age demonstrated similar rates of initial response, platinum resistance, PFS and OS to younger patients. Elderly women who can tolerate primary cytoreductive surgery should receive combination platinum-taxane chemotherapy.

5 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Par ses caractéristiques épidémiologiques, le cancer de l’ovaire constitute un modèle oncogériatrique par excellence. La surmortalité des patientes âgées s’explique, au-delà de l’âge chronologique seul, par une prise en charge souvent décrite comme suboptimale, et par l’intervention de facteurs indépendants, dépistés grâce à l’évaluation gériatrique. En l’absence de données prospectives spécifiques, les thérapeutiques dites «standard’ ont été calquées sur celles développées chez les patientes plus jeunes, et il existe aujourd’hui une contradiction entre les résultats «rassurants» des différents essais thérapeutiques, analysés en sousgroupes d’âges, et les analyses de pratiques, plus abstentionnistes à la fois en termes de prise en charge chirurgicale et médicale. L’avènement de la discipline oncogériatrique a permis le développement récent d’études cliniques «spécifiques» et d’interface clinico-biologique, qui permettront à l’avenir une meilleure adaptation des stratégies thérapeutiques. Ovarian cancer is an excellent model in geriatric oncology because of its epidemiological characteristics. Increased age is associated with poorer prognoses, partly due to suboptimal treatments but also to independent factors detected during geriatric assessment. In the absence of specific prospective data, treatments validated in younger patients are considered standard in this heterogeneous and fragile population. Today, a contradiction exists between reassuring data obtained from the analysis of age subgroups in large therapeutic studies and analyses of real practice, frequently involving ongoing care using surgical and chemotherapeutic treatments. The advent of geriatric oncology has allowed the development of specific clinical studies and the establishment of a clinical/biological interface that will provide data for the improved adaptation of therapeutic strategies.
    Oncologie 01/2008; 10(1):3-7. DOI:10.1007/s10269-007-0781-3 · 0.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: An algorithm is presented which is designed to yield reference pitch contours of speech signals for a comparative evaluation of pitch determination algorithms. For the task of pitch determination the question of error analysis in general and measurement accuracy in particular is discussed, It is shown that the accuracy of the algorithm must be better than 0.5% in order to render fine measurement errors inaudible. The algorithm uses the output signal of a laryngograph which measures the laryngeal vibrations via the changes of the electric impedance of the larynx. The point of inflection during the rapid rise of the laryngogram is taken as the estimate for the instant of glottal closure. Using a local interpolation filter the quantization error of the measurement is kept below 0.5%.
    Acoustics, Speech, and Signal Processing, IEEE International Conference on ICASSP '84.; 04/1984
  • [Show abstract] [Hide abstract]
    ABSTRACT: In Europe 58% of all female cancers occur in women older than 65 years. The incidence of ovarian cancer rises steadily with advancing age during adulthood and peaks in the 7th-8th decades of life. Age-specific analysis reveals that the incidence of and mortality rate from ovarian cancer are continuously increasing in the elderly population. Although more advanced stage at diagnosis seems to be one of the determinants of the worst prognosis of the elderly population, the majority of clinicians seem to be unprepared to treat elderly patients, and a great number of patients are under-treated for the fear of unacceptable side-effects, thus limiting their possibility of survival. Guidelines are clearly needed; including advice on whether to treat at all and whether standard surgery or chemotherapy is feasible in elderly patients with ovarian cancer. Research on MEDLINE using as keywords 'elderly and ovarian cancer' reveals few papers, which reported data in this field. Nonetheless, in this report we will focus on four basic aspects of ovarian cancer in the elderly: the most important factors affecting prognosis, the safety of surgical treatment in aged patients, optimal first and second line chemotherapy, and the use of supportive treatments to improve quality of life.
    Critical Reviews in Oncology/Hematology 02/2004; 49(1):77-86. DOI:10.1016/S1040-8428(03)00100-8 · 4.03 Impact Factor
Show more