Strategies for managing epithelial ovarian cancer in elderly patients: a comprehensive review

Authors

  • Sumedha Gupta Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  • Dheer Singh Kalwaniya Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242846

Keywords:

Elderly, Ovarian cancer, Older patients, Neoadjuvant chemotherapy

Abstract

The management of epithelial ovarian cancer in elderly patients presents distinct challenges due to age-related factors and comorbidities. Developing optimal strategies requires a careful balance between treatment efficacy and the potential side effects. This review aims to evaluate current management approaches specifically tailored to elderly patients with epithelial ovarian cancer. It focuses on the effectiveness and safety of various treatments, including surgery, chemotherapy, and targeted therapies, and considers how age-related factors influence treatment decisions and outcomes. Additionally, the review explores the importance of geriatric assessment and supportive care in optimizing treatment for this demographic. The findings suggest that managing epithelial ovarian cancer in elderly patients demands a multifaceted approach that considers both the effectiveness of the treatment and the patient's overall health and quality of life. By recognizing and addressing the unique needs of elderly patients, clinicians can refine treatment strategies, thereby improving outcomes for this vulnerable population. This approach emphasises the importance of individualized care that is responsive to the specific challenges posed by ageing and associated comorbidities, ultimately leading to better health outcomes for elderly patients with epithelial ovarian cancer.

References

National Cancer Institute. SEER Stat Fact Sheets: Ovary Cancer. Available at: http://seer.cancer.gov. Accessed on 2nd February 2014.

Soslow RA. Histologic subtypes of ovarian carcinoma: an overview. Int J Gynecol Pathol. 2008;27:161-74.

Chen S, Iversen ES, Friebel T, Finkelstein D, Weber BL, Eisen A, et al. Characterization of BRCA1 and BRCA2 mutations in a large United States sample. J Clin Oncol. 2006;24:863-71.

Tew WP, Lichtman SM. Ovarian cancer in older women. Semin Oncol 2008;35:582-9.

De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, et al. Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE--5-a population-based study. Lancet Oncol. 2014;15:23-34.

Lichtman SM. How I treat ovarian cancer in older women. J Geriatr Oncol 2014;5:223-9.

Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT, Vlastos G. Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol. 2007;25:1858-69.

Fourcadier E, Trétarre B, Gras-Aygon C, Ecarnot F, Daurès JP, Bessaoud F. Under-treatment of elderly patients with ovarian cancer: a population based study. BMC Cancer 2015;15:937.

Nightingale G, Hajjar E, Swartz K, Andrel-Sendecki J, Chapman A. Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. J Clin Oncol. 2015;33:1453-9.

Lichtman SM, Hollis D, Miller AA, Rosner GL, Rhoades CA, Lester EP, et al. Prospective evaluation of the relationship of patient age and paclitaxel clinical pharmacology:Cancer and Leukemia Group B (CALGB 9762). J Clin Oncol. 2006;24:1846-51.

Chen H, Cantor A, Meyer J, Beth Corcoran M, Grendys E, Cavanaugh D, et al. Can older cancer patients tolerate chemotherapy? A prospective pilot study. Cancer. 2003;97:1107-14.

Wenzel LB, Huang HQ, Armstrong DK, Walker JL, Cella D. Health-related quality of life during and after intraperitoneal versus intravenous chemotherapy for optimally debulked ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:437-43.

Vasey PA, Jayson GC, Gordon A, Gabra H, Coleman R, Atkinson R, et al. Phase III randomized trial of docetaxel-carboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma. J Natl Cancer Inst. 2004;96:1682-91.

Von Gruenigen VE, Huang HQ, Gil KM, Frasure HE, Armstrong DK, Wenzel LB. The association between quality of life domains and overall survival in ovarian cancer patients during adjuvant chemotherapy: a Gynecologic Oncology Group Study. Gynecol Oncol. 2012;124:379-82.

Landrum LM, Java J, Mathews CA, et al. Prognostic factors for stage III epithelial ovarian cancer treated with intraperitoneal chemotherapy: a Gynecologic Oncology Group study. Gynecol Oncol. 2013;130:12-18.

Ozols RF, Bundy BN, Greer BE. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with opti- mally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2003;21(17):3194-200.

Hou JY, Kelly MG, Yu H. Neoadjuvant chemotherapy lessens sur- gical morbidity in advanced ovarian cancer and leads to improved sur- vival in stage IV disease. Gynecol Oncol. 2007;105:211-7.

Aletti GD, Eisenhauer EL, Santillan A. Identifıcation of patient groups at highest risk from traditional approach to ovarian cancer treatment. Gynecol Oncol. 2011;120:23-8.

Hightower RD, Nguyen HN, Averette HE. National survey of ovarian carcinoma. IV: patterns of care and related survival for older patients. Cancer. 1994;73:377-83.

Ries LA. Ovarian cancer. Survival and treatment differences by age. Cancer. 1993;71(2):524-9.

Moore KN, Reid MS, Fong DN. Ovarian cancer in the octogenarian: does the paradigm of aggressive cytoreductive surgery and chemo-therapy still apply? Gynecol Oncol. 2008;110:133-9.

Thrall MM, Goff BA, Symons RG. Thirty-day mortality after primary cytoreductive surgery for advanced ovarian cancer in the elderly. Obstet Gynecol. 2011;118:537-47.

Wright JD, Lewin SN, Deutsch I. Defıning the limits of radical cytoreductive surgery for ovarian cancer. Gynecol Oncol. 2011;123:467-73.

Wright JD, Herzog TJ, Neugut AI. Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer. Obstet Gynecol. 2012;120:871-81.

Vergote I, Trope CG, Amant F. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. New Engl J Med. 2010;363:943-53.

Kehoe S, Hook J, Nankivel M. Chemotherapy or upfront surgery for newly diagnosed advanced ovarian cancer: results from the MRC CHORUS trial. J Clin Oncol. 2013;31:550.

Winter WE 3rd, Maxwell GL, Tian C. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2007;25:3621-7.

Fagotti A, Ferrandina MG, Vizzielli G. Randomized trial of primary debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer (SCORPION- NCT01461850). Int J Gynecol Cancer. 2020;30:1657-64.

Armstrong DK, Bundy B, Wenzel L. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. New Engl J Med. 2006;354:34-43.

Burger RA, Brady MF, Bookman MA. Incorporation of bevacizumab in the primary treatment of ovarian cancer. New Engl J Med. 2011;365:2473-83.

Perren TJ, Swart AM, Pfısterer J. A phase 3 trial of bevacizumab in ovarian cancer. New Engl J Med. 2011;365:2484-96.

Bookman MA, Brady MF, McGuire WP. Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: a phase III trial of the Gynecologic Cancer Intergroup. J Clin Oncol. 2009;27:1419-25.

Tew WP. Treatment outcomes for older women with advanced ovarian cancer: results from a phase III clinical trial (GOG 182). J Clin Oncol. 2010;28:15.

Sundararajan V, Hershman D, Grann VR. Variations in the use of chemotherapy for elderly patients with advanced ovarian cancer: a population-based study. J Clin Oncol. 2002;20:173-8.

Fairfıeld KM, Murray K, Lucas FL. Completion of adjuvant chemotherapy and use of health services for older women with epithelial ovarian cancer. J Clin Oncol. 2011;29:3921-6.

Von Gruenigen VE, Huang H, Tew WP. Geriatric assessment and tolerance to chemotherapy in elderly women with ovarian, primary peritoneal or fallopian tube cancer: a Gynecology Oncology Group study. Gynecol Oncol. 2014;133:439.

Freyer G, Geay JF, Touzet S. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol. 2005;16: 1795-1800.

Tre ́dan O, Geay JF, Touzet S. Carboplatin/cyclophosphamide or carboplatin/paclitaxel in elderly patients with advanced ovarian cancer? Analysis of two consecutive trials from the Groupe d’Investigateurs Na- tionaux pour l’Etude des Cancers Ovariens. Ann Oncol. 2007;18:256-62.

Falandry C, Weber B, Savoye AM. Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with fırst-line carboplatin: a GINECO prospective trial. Ann Oncol. 2013;24:2808-13.

Pignata S, Breda E, Scambia G. A phase II study of weekly carbo- platin and paclitaxel as fırst-line treatment of elderly patients with advanced ovarian cancer. A multicentre Italian trial in ovarian cancer (MITO-5) study. Crit Rev Oncol Hematol. 2008;66:229-36.

Pignata S, Scambia G, Katsaros D. Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol. 2014;15:396-405.

Lichtman SM, Wildiers H, Launay-Vacher V. International Society of Geriatric Oncology (SIOG) recommendations for the adjustment of dosing in elderly cancer patients with renal insuffıciency. Eur J Cancer. 2007;43:14-34.

Lichtman SM, Hollis D, Miller AA. Prospective evaluation of the relationship of patient age and paclitaxel clinical pharmacology: Cancer and Leukemia Group B (CALGB 9762). J Clin Oncol. 2006;24:1846-51.

Parmar MK, Ledermann JA, Colombo N. Paclitaxel plus platinum- based chemotherapy versus conventional platinum-based chemother- apy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR- 2.2 trial. Lancet. 2003;361:2099-106.

Pfısterer J, Plante M, Vergote I. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol. 2006;24:4699-707.

Kurtz JE, Kaminsky MC, Floquet A. Ovarian cancer in elderly patients: carboplatin and pegylated liposomal doxorubicin versus carboplatin and paclitaxel in late relapse-a Gynaecologic Cancer Intergroup (GCIG) CALYPSO sub-study. Ann Oncol. 2011;22:2417-23.

Bukowski RM, Ozols RF, Markman M. The management of recurrent ovarian cancer. Semin Oncol. 2007;34(2):1-15.

Gronlund B, Høgdall C, Hansen HH. Performance status rather than age is the key prognostic factor in second-line treatment of elderly patients with epithelial ovarian carcinoma. Cancer. 2002;94:1961-7.

Gordon AN, Tonda M, Sun S. Long-term survival advantage for women treated with pegylated liposomal doxorubicin compared with topotecan in a phase 3 randomized study of recurrent and refractory epithelial ovarian cancer. Gynecol Oncol. 2004;95:1-8.

Pujade-Lauraine E, Hilpert F, Weber B. Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: the AURELIA open-label randomized phase III trial. J Clin Oncol. 2014;32: 1302-8.

Burger RA, Sill MW, Monk BJ. Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer or primary peritoneal cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2007;25:5165-71.

Lewin SN, Buttin BM, Powell MA. Resource utilization for ovarian cancer patients at the end of life: how much is too much? Gynecol Oncol. 2005;99:261-6.

Audisio RA, Pope D. Shallweoperate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65:156-63.

Pope D, Ramesh H, Gennari R. Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol. 2006;15:189-97.

Chow WB, Rosenthal RA, Merkow RP. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215:453-66.

Huisman MG, van Leeuwen BL, Ugolini G. Timed up and go: a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicentre cohort study. PloS One. 2014;9:86863.

Won E, Hurria A, Feng T. CA125 level association with chemotherapy toxicity and functional status in older women with ovarian cancer. Int J Gynecol Cancer. 2013;23:1022-8.

Downloads

Published

2024-09-26

Issue

Section

Review Articles