TAMPA – The ability to perform daily activities was not associated with the completion of chemotherapy without dose reduction or delay in elderly women with ovarian, primary peritoneal, or fallopian tube cancer.
However, reporting limited social activities was significantly associated with decreased chemotherapy tolerance, reported Dr. Vivian E. von Gruenigen at the annual meeting of the Society of Gynecologic Oncology.
In the study, 149 women with a mean age of 77 years received carboplatin and paclitaxel (regimen 1) and 59 women with a mean age of 83 years received carboplatin alone (regimen 2), either after primary surgery or as neoadjuvant therapy. Among the study participants, 82% in regimen 1 and 54% in regimen 2 completed four cycles of the chemotherapy without dose reduction or delay of more than 7 days, and 92% in regimen 1 and 75% in regimen 2 eventually completed all cycles. Treatment delays of 7 days or longer were required by 18% of women in regimen 1 and 46% of women in regimen 2.
After adjusting for chemotherapy received, age, and performance status at baseline, instrumental activities of daily living (IADL) scores were not significantly associated with the ability to complete all four cycles (P = .2); only the report of limited social activities was significantly associated with the ability to complete all four cycles (P = .034), Dr. von Gruenigen of Northeastern Ohio Universities, Rootstown, reported during a late-breaking abstract session.
Women in the study were aged 70 years or older with newly diagnosed, pathology-confirmed adenocarcinoma of the ovary, peritoneum, or fallopian tube. The treatment regimen used was decided upon by the treating physician and patient. Those in regimen 1 received carboplatin (AUC 5) and paclitaxel (135 mg/m2 plus granulocyte colony-stimulating factor), every 3 weeks. Those in regimen 2 received carboplatin (AUC 5) every 3 weeks.
Geriatric assessment at baseline, before the third cycle, and after the fourth cycle included assessments of activities of daily living, quality of life, social activity, and social support. Since elderly women with primary ovarian cancer are less likely to be offered standard cancer treatments, develop higher levels of toxicity, and have lower survival rates, Dr. von Gruenigen and her colleagues aimed to determine whether the geriatric assessment was associated with the ability of elderly patients to complete platinum-based chemotherapy.
The study is the first large prospective U.S. study of elderly women with ovarian cancer, she said, noting that in addition to not being provided with appropriate care, few elderly women with ovarian cancer are included in clinical trials.
This is particularly concerning given that with the aging population, ovarian cancer rates will increase among the elderly, including among the "oldest of old."
"Chronological age does not automatically equal functional age. For healthcare professionals to apply study results to patients seen in clinical practice, we need to expand beyond measuring performance status as reported by us – the healthcare provider – and become more flexible with parameters of care," she said.
In the current study, patients in the regimen 1 and 2 groups were very different populations. In addition to being younger, having higher completion rates, and requiring fewer treatment delays, the women in the regimen 1 group were also fitter (11% vs. 37% had a performance status of 2-3), but the groups did not differ with respect to race or stage.
It is possible that physicians and patients are considering geriatric score and quality of life already when selecting treatment, Dr. von Gruenigen noted.
Regardless of therapy regimen, most patients eventually completed four cycles of chemotherapy, and quality of life improved over time – even in the very elderly.
A third "dose-dense" study arm involving weekly carboplatin and paclitaxel treatment was added in Aug. 13 after the initial two arms completed accrual. The new arm continues to accrue, and an analysis of pharmacokinetics is also ongoing.
Future study design may involve incorporating single-agent carboplatin into trials with the oldest patients.
"In summary, cautious management, appropriate treatment, and prevention of toxicity through interventions are needed in this elderly population," she said.
Dr. von Gruenigen reported having no disclosures.