Management of Recurrent Ovarian Cancer in Older Women

  • Nuria Romero
  • Franco MuggiaEmail author


Data on the treatment of recurrent ovarian cancer in the elderly has relied mostly on selected pilot studies. The largest study, ICON4 analyzes the elderly subset and does suggest that patients over 65 benefit from treatment with carboplatin + paclitaxel when the disease is categorized as platinum-sensitive as compared to single agents or other combinations. When the disease is platinum-resistant, preliminary results of the AURELIA study indicate that bevacizumab adds to the effect of chemotherapy, and this may also be applicable to the elderly. Nevertheless, there are a number of considerations relating to co-morbid conditions, adherence to treatment, and drug interactions that may pose a challenge in any one elderly individual undergoing chemotherapy treatments. Detection of early recurrences may be important, but this has not been studied specifically in an elderly population.


Ovarian cancer Relapse Management Pharmacology Pharmacokinetics 


  1. 1.
    Baker SD, Grochow LB. Pharmacology of cancer chemotherapy in the older person. Clin Geriatr Med. 1997;13:169.PubMedGoogle Scholar
  2. 2.
    Balkrishnan R. Predictors of medication adherence in the elderly. Clin Ther. 1998;20: 764–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Sawhney R, Sehl M, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part I. Cancer J. 2005;11:449.PubMedCrossRefGoogle Scholar
  4. 4.
    Schrijvers D, Highley M, De Bruyn E, et al. Role of red blood cells in pharmacokinetics of chemotherapeutic agents. Anticancer Drugs. 1999;10:147.PubMedCrossRefGoogle Scholar
  5. 5.
    Sehl M, Sawhney R, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part II. Cancer J. 2005;11:461.PubMedCrossRefGoogle Scholar
  6. 6.
    Launay-Vacher V, Chatelut E, Lichtman SM, et al. Renal insufficiency in elderly cancer patients: International Society of Geriatric Oncology clinical practice recommendations. Ann Oncol. 2007;18:1314.PubMedCrossRefGoogle Scholar
  7. 7.
    Wright JG, Boddy AV, Highley M, et al. Estimation of glomerular filtration rate in cancer patients. Br J Cancer. 2001;84:452–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Vestal RE. Aging and pharmacology. Cancer. 1997;80:1302.PubMedCrossRefGoogle Scholar
  9. 9.
    Tam-McDevitt J. Polypharmacy, aging, and cancer. Oncology (Williston Park). 2008; 22:1052.Google Scholar
  10. 10.
    Chan JK, Urban R, Cheung MK, et al. Ovarian cancer in younger vs older women: a population-based analysis. Br J Cancer. 2006;95:1314–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Winter 3rd WE, Maxwell GL, Tian C, et al. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:3621–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Pectasides D, Fountzilas G, Aravantinos G, et al. Epithelial ovarian carcinoma in younger vs older women: is age an independent prognostic factor? The Hellenic Oncology Cooperative Group experience. Int J Gynecol Cancer. 2007;17:1003–10.PubMedCrossRefGoogle Scholar
  13. 13.
    Maas HA, Kruitwagen RF, Lemmens VE, et al. The influence of age and co-morbidity on treatment and prognosis of ovarian cancer: a population-based study. Gynecol Oncol. 2005;97:104–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Petignant P, Fioretta G, Verkooijen HM, et al. Poorer survival of elderly patients with ovarian cancer: a population-based study. Surg Oncol. 2004;13:181–6.CrossRefGoogle Scholar
  15. 15.
    Sundarajan V, Hershman D, Grann VR, et al. Variations in the use of chemotherapy for elderly patients with advanced ovarian cancer: a population-based study. J Clin Oncol. 2002;20:173–8.CrossRefGoogle Scholar
  16. 16.
    Efstathiou E, Dimopoulos MA, Bozas G, et al. Advanced epithelial ovarian cancer in the elderly: chemotherapy tolerance and outcome. Anticancer Res. 2007;27:611–7.PubMedGoogle Scholar
  17. 17.
    Hershman D, Jacobson JS, McBride R, et al. Efectiveness of platinum-based chemotherapy among elderly patients with advanced ovarian cancer. Gynecol Oncol. 2004;94:540–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Freyer G, Tinker AV, Gynecologic Cancer InterGroup. Clinical trials and treatment of the elderly diagnosed with ovarian cancer. Int J Gynecol Cancer. 2011;21(4):776–81.PubMedCrossRefGoogle Scholar
  19. 19.
    Thigpen T, Brady MF, Omura GA, et al. Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group study. Cancer. 1993;71:606–14.PubMedCrossRefGoogle Scholar
  20. 20.
    Ben-Ami I, Vaknin Z, Schneider D, et al. Perioperative morbidity and mortality of gynecological oncologic surgery in elderly women. Int J Gynecol Cancer. 2006;16:452–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Wright JD, Herzog TJ, Powell MA. Morbidity of cytoreductive surgery in the elderly. Am J Obstet Gynecol. 2004;190(5):1398–400.PubMedCrossRefGoogle Scholar
  22. 22.
    Fotopoulou C, Savvatis K, Steinhagen-Thiessen E, et al. Primary radical surgery in elderly patients with epithelial ovarian cancer: analysis of surgical outcome and long-term survival. Int J Gynecol Cancer. 2010;20:34–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Cloven NG, Manetta A, Berman ML, et al. Management of ovarian cancer in patients older than 80 years of age. Gynecol Oncol. 1999;73:137–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Marchetti DL, Lele SB, Priore RL, et al. Treatment of advanced ovarian carcinoma in the elderly. Gynecol Oncol. 1993;49:86–91.PubMedCrossRefGoogle Scholar
  25. 25.
    Diaz-Montes TP, Zahurak ML, Giuntoli RL, et al. Surgical care of elderly women with ovarian cancer: a population-based perspective. Gynecol Oncol. 2005;99:352–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Al-Refaie WB, Parsons HM, Henderson WG, et al. Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg. 2010;251(2):311–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Alphs HH, Zahurak ML, Bristow RE, et al. Predictors of surgical outcome and survival among elderly women diagnosed with ovarian and primary peritoneal cancer. Gynecol Oncol. 2006;103:1048–53.PubMedCrossRefGoogle Scholar
  28. 28.
    Audisio RA, Pope D, Ramesh HS, et al. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65:156–63.PubMedCrossRefGoogle Scholar
  29. 29.
    McLean KA, Shah CA, Thompson SA, et al. Ovarian cancer in the elderly: outcomes with neoadjuvant chemotherapy or primary cytoreduction. Gynecol Oncol. 2010;18:43–6.CrossRefGoogle Scholar
  30. 30.
    Vergote I, Tropé CG, Amant F, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363(10):943–53.PubMedCrossRefGoogle Scholar
  31. 31.
    Talarico L, Chen G, Pazdur R. Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol. 2004;22:4626–31.PubMedCrossRefGoogle Scholar
  32. 32.
    Wright JD, Doan T, McBride R, et al. Variability in chemotherapy delivery for elderly women with advanced stage ovarian cancer and its impact on survival. Br J Cancer. 2008;98:1197–203.PubMedCrossRefGoogle Scholar
  33. 33.
    Hilpert F, du Bois A, Greimel ER, et al. Feasibility, toxicity and quality of life of first-line chemotherapy with platinum/paclitaxel in elderly patients aged  >  or  =  70 years with advanced ovarian cancer: a study by the AGO OVAR Germany. Ann Oncol. 2007;18:282–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Eisenhauer EL, Tew WP, Levine DA, et al. Response and outcomes in elderly patients with stages III-IV ovarian cancer receiving platinum-taxane chemotherapy. Gynecol Oncol. 2007;106:381–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Trédan O, Geay JF, Touzet S, et al. Carboplatin/cyclophosphamyde or carboplatin/paclitaxel in elderly patients with advanced ovarian cancer? Analysis of two consecutive trials from the Group d’Investigateurs Nationaux pour I’Etude des Cancers Ovariens. Ann Oncol. 2007;18:256–62.PubMedCrossRefGoogle Scholar
  36. 36.
    Pignata S, Breda E, Scambia G, et al. A phase II study of weekly carboplatin and paclitaxel as first-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.PubMedCrossRefGoogle Scholar
  37. 37.
    Fader AN, von Gruenigen V, Gibbons H, et al. Improved tolerance of primary chemotherapy with reduced-dose carboplatin and paclitaxel in elderly ovarian cancer patients. Gynecol Oncol. 2008;109:33–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Kurtz JE, Kaminsky MC, Floquet A, et al. Ovarian cancer in elderly patients: carboplatin and pegylated liposomal doxorubicin versus carboplatin and paclitaxel in late relapse: a Gynecologic Cancer Intergroup (GCIG) CALYPSO sub-study. Ann Oncol. 2011;22(11):2417–23. Epub 2011 Mar 14.PubMedCrossRefGoogle Scholar
  39. 39.
    Pignata S, Ferrandina G, Scarfone G, et al. Poor outcome of elderly patients with platinum-sensitive recurrent ovarian cancer: results from the SOCRATES retrospective study. Crit Rev Oncol Hematol. 2009;71:233–41.PubMedCrossRefGoogle Scholar
  40. 40.
    Parmar MK, Lederman JA, Colombo N, et al. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet. 2003;361:2099–106.PubMedCrossRefGoogle Scholar
  41. 41.
    Perren TJ, Swart AM, Pfisterer J, et al. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med. 2011;365:2484–96.PubMedCrossRefGoogle Scholar
  42. 42.
    Muggia F. Bevacizumab: role in first-line ovarian cáncer. Drugs 2012;72(2):931–6Google Scholar
  43. 43.
    Cassidy J, Saltz LB, Giantonio BJ, et al. Effect of bevacizumab in older patients with metastatic colorectal cancer: pooled analysis of four randomized studies. J Cancer Res Clin Oncol. 2010;136:737–43.PubMedCrossRefGoogle Scholar
  44. 44.
    Laskin J, Crinò L, Felip E, et al. Safety and efficacy of first-line Bevacizumab plus chemotherapy in elderly patients with advanced or recurrent nonsquamous non-small cell lung cancer: safety of avastin in lung trial (MO19390). J Thorac Oncol. 2012;7:203–11.PubMedCrossRefGoogle Scholar
  45. 45.
    Price TJ, Zannino D, Wilson K, et al. Bevacizumab is equally effective and no more toxic in elderly patients with advanced colorectal cancer: a subgroup analysis from the AGITG MAX trial: an international randomised controlled trial of Capecitabine, Bevacizumab and Mitomycin C. Ann Oncol. 2012;23(6):1531–6. Epub 2011 Oct 29.PubMedCrossRefGoogle Scholar
  46. 46.
    Reifenstein EC. The treatment of advanced endometrial cancer with hydroxyprogesterone caproate. Gynecol Oncol. 1974;2:377–414.PubMedCrossRefGoogle Scholar
  47. 47.
    Piver MS, Barlow JJ, Lurain JR, Blumenson LE. Medroxyprogesterone acetate (Depo Provera) vs. hydroxyprogesterone caproate (Delalutin) in women with metastatic endometrial adenocarcinoma. Cancer. 1980;45:268.PubMedCrossRefGoogle Scholar
  48. 48.
    Thigpen JT, Brady MF, Alvarez RD, et al. Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose–response study by the Gynecologic Oncology Group. J Clin Oncol. 1999;17:1736.PubMedGoogle Scholar
  49. 49.
    Markman M. Hormonal therapy of endometrial cancer. Eur J Cancer. 2005;41:673.PubMedCrossRefGoogle Scholar
  50. 50.
    Thigpen T, Brady MF, Homesley HD, et al. Tamoxifen in the treatment of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2001;19:364.PubMedGoogle Scholar
  51. 51.
    Whitney CW, Brunetto VL, Zaino RJ, et al. Phase II study of medroxyprogesterone acetate plus tamoxifen in advanced endometrial carcinoma: Gynecologic Oncology Group study. Gynecol Oncol. 2004;92:4–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Fiorica JV, Brunetto VL, Hanjani P, et al. Phase II trial of alternating courses of megestrol acetate and tamoxifen in advanced endometrial carcinoma. Gynecol Oncol. 2004;92:10–4.PubMedCrossRefGoogle Scholar
  53. 53.
    Ma BB, Oza A, Eisanhauer E, et al. The activity of letrozole in patients with advanced or recurrent endometrial cáncer and correlation with biological markers: a study of the National Cancer Institute of Canada Clinical Trials Group. Int J Gynecol Cancer. 2004;14:650.PubMedCrossRefGoogle Scholar
  54. 54.
    Rose PG, Brunetto VL, VanLe L, et al. A phase II trial of anastrozole in advanced recurrent or persistent endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2000;78:212–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Chouliara Z, Kearny N, Stott D, et al. Perceptions of older people with cancer information, decision making and treatment: a systematic review of selected literature. Ann Oncol. 2004;15:1596–602.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Medical OncologyNYU Cancer InstituteNew YorkUSA

Personalised recommendations