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Chemotherapy: First-Line Strategy

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Ovarian Cancer in Elderly Patients

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Abstract

While standard first-line chemotherapy with 3-weekly carboplatin AUC 5mg/mL/min and paclitaxel 175 mg/m² in advanced ovarian cancer may be feasible in selected elderly patients such as those included in prospective trials, in a wider selection of patients ≥70, as this is the case in everyday practice, the standard carboplatin-paclitaxel regimen has shown an excess of toxicity and led to premature treatment stopping. For elderly patients thought to be vulnerable and at high risk of toxicity with the standard 3-weekly carboplatin-paclitaxel regimen, other options are commonly used: carboplatin as a single agent and carboplatin-paclitaxel regimen in a weekly schedule for both drugs. To date, there is no randomized trial to give practitioners some evidence on how to select patients who could benefit from one or the other regimen described above. The GINECO has therefore designed EWOC-1 (Elderly Women Ovarian Cancer), an international multicenter randomized phase II trial, to compare three different regimens: paclitaxel + carboplatin every 3 weeks, single-agent carboplatin every 3 weeks and weekly paclitaxel and carboplatin in a selected population of vulnerable elderly patients (ClinicalTrials.gov identifier NCT02001272).

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References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer J Int du Cancer. 2015;136(5):E359–86.

    Article  CAS  Google Scholar 

  2. Oberaigner W, Minicozzi P, Bielska-Lasota M, Allemani C, de Angelis R, Mangone L, et al. Survival for ovarian cancer in Europe: the across-country variation did not shrink in the past decade. Acta Oncol. 2012;51(4):441–53.

    Article  PubMed  Google Scholar 

  3. Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31(2):128–36.

    Article  PubMed  Google Scholar 

  4. Lowe KA, Chia VM, Taylor A, O’Malley C, Kelsh M, Mohamed M, et al. An international assessment of ovarian cancer incidence and mortality. Gynecol Oncol. 2013;130(1):107–14.

    Article  PubMed  Google Scholar 

  5. Yancik R. Ovarian cancer. Age contrasts in incidence, histology, disease stage at diagnosis, and mortality. Cancer. 1993;71(2 Suppl):517–23.

    CAS  PubMed  Google Scholar 

  6. Berchuck A, Kohler MF, Boente MP, Rodriguez GC, Whitaker RS, Bast RC, Bast Jr RC. GROWTH regulation and transformation of ovarian epithelium. Cancer. 1993;71(2 Suppl):545–51.

    CAS  PubMed  Google Scholar 

  7. Zola P, Ferrero A. Is carboplatin-paclitaxel combination the standard treatment of elderly ovarian cancer patients? Ann Oncol. 2007;18(2):213–4.

    Article  CAS  PubMed  Google Scholar 

  8. Bruchim I, Altaras M, Fishman A. Age contrasts in clinical characteristics and pattern of care in patients with epithelial ovarian cancer. Gynecol Oncol. 2002;86(3):274–8.

    Article  PubMed  Google Scholar 

  9. Hurria A, Cirrincione CT, Muss HB, Kornblith AB, Barry W, Artz AS, et al. Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401. J Clin Oncol. 2011;29(10):1290–6.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457–65.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Freyer G, Geay JF, Touzet S, Provencal J, Weber B, Jacquin JP, et al. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol. 2005;16(11):1795–800.

    Article  CAS  PubMed  Google Scholar 

  12. Falandry C, Weber B, Savoye AM, Tinquaut F, Tredan O, Sevin E, et al. Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with first-line carboplatin: a GINECO prospective trial. Ann Oncol. 2013;24(11):2808–13.

    Article  CAS  PubMed  Google Scholar 

  13. Piccart MJ, Bertelsen K, James K, Cassidy J, Mangioni C, Simonsen E, et al. Randomized intergroup trial of cisplatin-paclitaxel versus cisplatin-cyclophosphamide in women with advanced epithelial ovarian cancer: three-year results. J Natl Cancer Inst. 2000;92(9):699–708.

    Article  CAS  PubMed  Google Scholar 

  14. du Bois A, Luck HJ, Meier W, Adams HP, Mobus V, Costa S, et al. A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst. 2003;95(17):1320–9.

    Article  PubMed  Google Scholar 

  15. Ozols RF, Bundy BN, Greer BE, Fowler JM, Clarke-Pearson D, Burger RA, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2003;21(17):3194–200.

    Article  CAS  PubMed  Google Scholar 

  16. Mcguire WP, Hoskins WJ, Brady MF, Kucera PR, Partridge EE, Look KY, et al. Cyclophosphamide and cisplatin versus paclitaxel and cisplatin: a phase III randomized trial in patients with suboptimal stage III/IV ovarian cancer (from the Gynecologic Oncology Group). Semin Oncol. 1996;23(5 Suppl 12):40–7.

    CAS  PubMed  Google Scholar 

  17. Swenerton K, Jeffrey J, Stuart G, Roy M, Krepart G, Carmichael J, et al. Cisplatin-cyclophosphamide versus carboplatin-cyclophosphamide in advanced ovarian cancer: a randomized phase III study of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 1992;10(5):718–26.

    CAS  PubMed  Google Scholar 

  18. Hershman D, Jacobson JS, Mcbride R, Mitra N, Sundararajan V, Grann VR, et al. Effectiveness of platinum-based chemotherapy among elderly patients with advanced ovarian cancer. Gynecol Oncol. 2004;94(2):540–9.

    Article  CAS  PubMed  Google Scholar 

  19. Sundararajan V, Hershman D, Grann VR, Jacobson JS, Neugut AI. Variations in the use of chemotherapy for elderly patients with advanced ovarian cancer: a population-based study. J Clin Oncol. 2002;20(1):173–8.

    Article  PubMed  Google Scholar 

  20. Fairfield KM, Murray K, Lucas FL, Wierman HR, Earle CC, Trimble EL, et al. Completion of adjuvant chemotherapy and use of health services for older women with epithelial ovarian cancer. J Clin Oncol. 2011;29(29):3921–6.

    Article  PubMed  Google Scholar 

  21. Maas HA, Kruitwagen RF, Lemmens VE, Goey SH, Janssen-Heijnen ML. The influence of age and co-morbidity on treatment and prognosis of ovarian cancer: a population-based study. Gynecol Oncol. 2005;97(1):104–9.

    Article  CAS  PubMed  Google Scholar 

  22. Gajra A, Klepin HD, Feng T, Tew WP, Mohile SG, Owusu C, et al. Predictors of chemotherapy dose reduction at first cycle in patients age 65years and older with solid tumors. J Geriatr Oncol. 2015;6(2):133–40.

    Article  PubMed  Google Scholar 

  23. Ceccaroni M, D’agostino G, Ferrandina G, Gadducci A, di Vagno G, Pignata S, et al. Gynecological malignancies in elderly patients: is age 70 a limit to standard-dose chemotherapy? An Italian retrospective toxicity multicentric study. Gynecol Oncol. 2002;85(3):445–50.

    Article  CAS  PubMed  Google Scholar 

  24. Tew WP, Java J, Chi D, Menzin A, Lovecchio JL, Bookman MA, et al. Treatment outcomes for older women with advanced ovarian cancer: results from a phase III clinical trial (GOG182). J Clin Oncol. 2010;28:15s. suppl; abstr 5030.

    Google Scholar 

  25. Hilpert F, du BOIS A, Greimel ER, Hedderich J, Krause G, Venhoff L, 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(2):282–7.

    Google Scholar 

  26. Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist. 2000;5(3):224–37.

    Article  CAS  PubMed  Google Scholar 

  27. Tredan O, Geay JF, Touzet S, Delva R, Weber B, Cretin J, et al. Carboplatin/cyclophosphamide or carboplatin/paclitaxel in elderly patients with advanced ovarian cancer? Analysis of two consecutive trials from the Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens. Ann Oncol. 2007;18(2):256–62.

    Article  CAS  PubMed  Google Scholar 

  28. Pignata S, Monfardini S. Single agents should be administered in preference to combination chemotherapy for the treatment of patients over 70 years of age with advanced ovarian carcinoma. Eur J Cancer. 2000;36(7):817–20.

    Article  CAS  PubMed  Google Scholar 

  29. International Collaborative Ovarian Neoplasm Group. Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet. 2002;360(9332):505–15.

    Article  Google Scholar 

  30. Pignata S, Breda E, Scambia G, Pisano C, Zagonel V, Lorusso D, 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(3):229–36.

    Article  PubMed  Google Scholar 

  31. Pignata S, Scambia G, Katsaros D, Gallo C, Pujade-Lauraine E, de Placido S, et al. 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(4):396–405.

    Article  CAS  PubMed  Google Scholar 

  32. von Gruenigen VE, Huang H, Tew W, Hurria AH, Lankes H, Disilvestro PA, et al. 3Geriatric assessment and tolerance to chemotherapy in elderly women with ovarian, primary peritoneal or fallopian tube cancer: a Gynecologic Oncology Group study. Gynecol Oncol. 2014;134(2):438–40.

    Google Scholar 

  33. Fader AN, von Gruenigen V, Gibbons H, Abushahin F, Starks D, Markman M, et al. Improved tolerance of primary chemotherapy with reduced-dose carboplatin and paclitaxel in elderly ovarian cancer patients. Gynecol Oncol. 2008;109(1):33–8.

    Article  CAS  PubMed  Google Scholar 

  34. Bookman MA, Brady MF, Mcguire WP, Harper PG, Alberts DS, Friedlander M, et al. 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(9):1419–25.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Alberts DS, Liu PY, Hannigan EV, O’toole R, Williams SD, Young JA, et al. Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med. 1996;335(26):1950–5.

    Article  CAS  PubMed  Google Scholar 

  36. Armstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R, Lele S, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354(1):34–43.

    Article  CAS  PubMed  Google Scholar 

  37. Markman M, Bundy BN, Alberts DS, Fowler JM, Clark-Pearson DL, Carson LF, et al. Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and Intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol. 2001;19(4):1001–7.

    CAS  PubMed  Google Scholar 

  38. Tew WP, O'Cearbhaill R, Zhou Q, Thaler H, Konner J, Hensley ML, et al. Intraperitoneal chemotherapy in older women with epithelial ovarian cancer. J Clin Oncol. 2009;27:[abstr ♯5541].

    Google Scholar 

  39. Burger RA, Brady MF, Bookman MA, Fleming GF, Monk BJ, Huang H, et al. Incorporation of Bevacizumab in the primary treatment of ovarian cancer. N Engl J Med. 2011;365(26):2473–83.

    Article  CAS  PubMed  Google Scholar 

  40. Mohile SG, Hardt M, Tew W, Owusu C, Klepin H, Gross C, et al. Toxicity of Bevacizumab in combination with chemotherapy in older patients. Oncologist. 2013;18(4):408–14.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Wright JD, Ananth CV, Tsui J, Glied SA, Burke WM, Lu YS. Comparative effectiveness of upfront treatment strategies in elderly women with ovarian cancer. Cancer. 2014;120(8):1246–54.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Fotopoulou C, Savvatis K, Steinhagen-Thiessen E, Bahra M, Lichtenegger W, Sehouli J. Primary radical surgery in elderly patients with epithelial ovarian cancer: analysis of surgical outcome and long-term survival. Int J Gynecol Cancer. 2010;20(1):34–40.

    Article  PubMed  Google Scholar 

  43. Wright JD, Herzog TJ, Neugut AI, Burke WM, Lu YS, Lewin SN. Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer. Obstet Gynecol. 2012;120(4):871–81.

    Article  PubMed  Google Scholar 

  44. Kang S, Nam BH. Does neoadjuvant chemotherapy increase optimal cytoreduction rate in advanced ovarian cancer? Meta-analysis of 21 studies. Ann Surg Oncol. 2009;16(8):2315–20.

    Article  PubMed  Google Scholar 

  45. Mclean KA, Shah CA, Thompson SA, Gray HJ, Swensen RE, Goff BA. Ovarian cancer in the elderly: outcomes with neoadjuvant chemotherapy or primary cytoreduction. Gynecol Oncol. 2010;118(1):43–6.

    Article  PubMed  Google Scholar 

  46. Vergote I, Trope CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363(10):943–53.

    Article  CAS  PubMed  Google Scholar 

  47. van Meurs HS, Tajik P, Hof MH, Vergote I, Kenter GG, Mol BW, et al. Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial. Eur J Cancer. 2013;49(15):3191–201.

    Article  PubMed  Google Scholar 

  48. Aletti GD, Eisenhauer EL, Santillan A, Axtell A, Aletti G, Holschneider C, et al. Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment. Gynecol Oncol. 2011;120(1):23–8.

    Article  PubMed  Google Scholar 

  49. Thrall MM, Goff BA, Symons RG, Flum DR, Gray HJ. Thirty-day mortality after primary cytoreductive surgery for advanced ovarian cancer in the elderly. Obstet Gynecol. 2011;118(3):537–47.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Vergote I, du Bois A, Amant F, Heitz F, Leunen K, Harter P. Neoadjuvant chemotherapy in advanced ovarian cancer: on what do we agree and disagree? Gynecol Oncol. 2013;128(1):6–11.

    Article  PubMed  Google Scholar 

  51. Falandry C, Fabbro M, Lesoin A, Guerin O, Kurtz JE. 1ères recommandations sur le cancer de l’ovaire. Nice-St Paul de Vence 2012. Cancer de l’ovaire de la patiente âgée. Onko+. 2013;5(2):40.

    Google Scholar 

  52. Rutten MJ, Leeflang MM, Kenter GG, Mol BW, Buist M. Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer. Cochrane Database Syst Rev. 2014;2, CD009786.

    PubMed  Google Scholar 

  53. Rutten MJ, Gaarenstroom KN, van Gorp T, van Meurs HS, Arts HJ, Bossuyt PM, et al. Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study. BMC Cancer. 2012;12:31.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Medical Oncology Department, Centre Hospitalier Lyon Sud - Institut de Cancérologie des Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, Pierre-Bénite, 69310, France

    Olivia Le Saux

  2. Lyon 1 University, EMR 3738, Faculté de Médecine Lyon-Sud, 165, Chemin du Petit Revoyet - BP12, Oullins Cedex, 69921, France

    Olivia Le Saux

  3. Geriatric Oncology Department, Centre Hospitalier Lyon Sud - Institut de Cancérologie des Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, Pierre-Bénite, 69310, France

    Claire Falandry MD, PhD

  4. HCL Cancer Institute, Medical Oncology, and Université de Lyon, Lyon, France

    Gilles Freyer MD, PhD

Authors
  1. Olivia Le Saux
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  2. Claire Falandry MD, PhD
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  3. Gilles Freyer MD, PhD
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Correspondence to Olivia Le Saux .

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Editors and Affiliations

  1. HCL Cancer Institute, Medical Oncology, and Université de Lyon , Lyon, France

    Gilles Freyer

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Le Saux, O., Falandry, C., Freyer, G. (2016). Chemotherapy: First-Line Strategy. In: Freyer, G. (eds) Ovarian Cancer in Elderly Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-23588-2_5

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  • DOI: https://doi.org/10.1007/978-3-319-23588-2_5

  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-23588-2

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