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Ovarian Cancer in the Older Woman

  • Mohammad HissourouIII
  • William P. Tew
Living reference work entry

Abstract

Ovarian cancer is the seventh most common cancer in women worldwide and accounts for nearly 4% of all new cases of cancer in women. Almost half of all ovarian cancer patients are over the age of 65 at diagnosis, and over 70% of deaths from ovarian cancer are occurring in this same age group. As the population ages, the number of older women with ovarian cancer is increasing. Compared to younger women, older women with ovarian cancer receive less surgery and chemotherapy, develop worse toxicity, and have poorer outcomes. They are also significantly underrepresented in clinical trials, and thus application of standard treatment regimens can be challenging. Performance status alone has been shown to be an inadequate tool to predict toxicity of older patients from chemotherapy. The use of formal geriatric assessment tools is a promising direction for stratifying older patients on trials. Elderly-specific trials and adjustments to the eligibility criteria of current frontline trials may allow greater participation of older women. Modified treatment regimens and interventions to decrease morbidities in the vulnerable older population should be useful.

Keywords

Ovarian cancer Geriatric oncology Geriatric assessment Neoadjuvant chemotherapy 

References

  1. 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. PubMed PMID: 8960474CrossRefPubMedGoogle Scholar
  2. 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. PubMed PMID: 20933255CrossRefPubMedGoogle Scholar
  3. 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. PubMed PMID: 16394300CrossRefPubMedGoogle Scholar
  4. Boyd J, Sonoda Y, Federici MG, Bogomolniy F, Rhei E, Maresco DL, et al. Clinicopathologic features of BRCA-linked and sporadic ovarian cancer. JAMA J Am Med Assoc. 2000;283(17):2260–5. PubMed PMID: 10807385CrossRefGoogle Scholar
  5. 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. PubMed PMID: 22204724CrossRefPubMedGoogle Scholar
  6. Cascales-Campos P, Gil J, Gil E, Feliciangeli E, Lopez V, Gonzalez AG, et al. Cytoreduction and HIPEC after neoadjuvant chemotherapy in stage IIIC-IV ovarian cancer. Critical analysis in elderly patients. Eur J Obstet Gynecol Reprod Biol. 2014;179:88–93. PubMed PMID: 24965986CrossRefPubMedGoogle Scholar
  7. Du Bois A, Floquet A, Kim JW, Rau J, Del Campo JM, Friedlander M, et al. Randomized, double-blind, phase III trial of pazopanib versus placebo in women who have not progressed after first-line chemotherapy for advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (AEOC): results of an international intergroup trial (AGO-OVAR16). J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(Suppl; abstr LBA5503)CrossRefGoogle Scholar
  8. Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Yancik R, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer. 2002;94(10):2766–92. PubMed PMID: 12173348CrossRefPubMedGoogle Scholar
  9. Fairfield KM, Lucas FL, Earle CC, Small L, Trimble EL, Warren JL. Regional variation in cancer-directed surgery and mortality among women with epithelial ovarian cancer in the Medicare population. Cancer. 2010;116(20):4840–8. PubMed PMID: 20578182CrossRefPubMedGoogle Scholar
  10. 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 Off J Am Soc Clin Oncol. 2011;29(29):3921–6. PubMed PMID: 21911719CrossRefGoogle Scholar
  11. Fairfield KM, Murray K, LaChance JA, Wierman HR, Earle CC, Trimble EL, et al. Intraperitoneal chemotherapy among women in the Medicare population with epithelial ovarian cancer. Gynecol Oncol. 2014;134:473–7. PubMed PMID: 24952367CrossRefPubMedGoogle Scholar
  12. Falandry C, Horard B, Alexandre J, Deplanque G, Cojocarasu O, Salvat J, et al. Correlation of short telomeres (ST) with vulnerability, toxicity, and early death in elderly AOC patients receiving carboplatin: a multicenter GINECO trial. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(suppl; abstr 9011)Google Scholar
  13. 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 Off J Eur Soc Med Oncol ESMO. 2013;24(11):2808–13. PubMed PMID: 24061628CrossRefGoogle Scholar
  14. 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 Off J Eur Soc Med Oncol ESMO. 2005;16(11):1795–800. PubMed PMID: 16093275CrossRefGoogle Scholar
  15. Gonsalves W, Ganti AK. Targeted anti-cancer therapy in the elderly. Crit Rev Oncol Hematol. 2011;78(3):227–42. PubMed PMID: 20599391CrossRefPubMedGoogle Scholar
  16. Goss GD, Arnold A, Shepherd FA, Dediu M, Ciuleanu TE, Fenton D, et al. Randomized, double-blind trial of carboplatin and paclitaxel with either daily oral cediranib or placebo in advanced non-small-cell lung cancer: NCIC clinical trials group BR24 study. J Clin Oncol Off J Am Soc Clin Oncol. 2010;28(1):49–55. PubMed PMID: 19917841CrossRefGoogle Scholar
  17. Griffiths RW, Zee YK, Evans S, Mitchell CL, Kumaran GC, Welch RS, et al. Outcomes after multiple lines of chemotherapy for platinum-resistant epithelial cancers of the ovary, peritoneum, and fallopian tube. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2011;21(1):58–65. PubMed PMID: 21178570CrossRefGoogle Scholar
  18. Gronlund B, Hogdall C, Hansen HH, Engelholm SA. Performance status rather than age is the key prognostic factor in second-line treatment of elderly patients with epithelial ovarian carcinoma. Cancer. 2002;94(7):1961–7. PubMed PMID: 11932898CrossRefPubMedGoogle Scholar
  19. Hightower RD, Nguyen HN, Averette HE, Hoskins W, Harrison T, Steren A. National survey of ovarian carcinoma. IV: patterns of care and related survival for older patients. Cancer. 1994;73(2):377–83. PubMed PMID: 8293403CrossRefPubMedGoogle Scholar
  20. 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 Off J Am Soc Clin Oncol. 2011a;29(10):1290–6. PubMed PMID: 21357782. Pubmed Central PMCID: 3083997CrossRefGoogle Scholar
  21. 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 Off J Am Soc Clin Oncol. 2011b;29(25):3457–65. PubMed PMID: 21810685. Pubmed Central PMCID: 3624700CrossRefGoogle Scholar
  22. Insert AP. Highlights of prescribing information. 2014Google Scholar
  23. Kanesvaran R, Li H, Koo KN, Poon D. Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(27):3620–7. PubMed PMID: 21859998CrossRefGoogle Scholar
  24. Kaye SB, Lubinski J, Matulonis U, Ang JE, Gourley C, Karlan BY, et al. Phase II, open-label, randomized, multicenter study comparing the efficacy and safety of olaparib, a poly (ADP-ribose) polymerase inhibitor, and pegylated liposomal doxorubicin in patients with BRCA1 or BRCA2 mutations and recurrent ovarian cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(4):372–9. PubMed PMID: 22203755CrossRefGoogle Scholar
  25. Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener HC, Lopes T, et al. Chemotherapy or upfront surgery for newly diagnosed advanced ovarian cancer: results from the MRC CHORUS trial. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(suppl):Abstr 5500Google Scholar
  26. Kurtz JE, Kaminsky MC, Floquet A, Veillard AS, Kimmig R, Dorum 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 Off J Eur Soc Med Oncol ESMO. 2011;22(11):2417–23. PubMed PMID: 21402619CrossRefGoogle Scholar
  27. Langstraat C, Aletti GD, Cliby WA. Morbidity, mortality and overall survival in elderly women undergoing primary surgical debulking for ovarian cancer: a delicate balance requiring individualization. Gynecol Oncol. 2011;123(2):187–91. PubMed PMID: 21794902CrossRefPubMedGoogle Scholar
  28. Ledermann JA, Perren T, Raja FA, Embleton AC, Rustin GJS, Jayson G, et al. Randomized double-blind phase III trial of cediranib (AZE 2171) in relapsed platinum sensitive ovarian cancer: results of the ICON6 trial. NCRI conference. 2013. p. LB80Google Scholar
  29. Lewin SN, Buttin BM, Powell MA, Gibb RK, Rader JS, Mutch DG, et al. Resource utilization for ovarian cancer patients at the end of life: how much is too much? Gynecol Oncol. 2005;99(2):261–6. PubMed PMID: 16140364CrossRefPubMedGoogle Scholar
  30. Liu J, Barry WT, Birrer MJ, Lee J, Buckanovich R, Fleming GF, et al. A randomized phase 2 trial comparing efficacy of the combination of the PARP inhibitor olaparib and the antiangiogenic cediranib against olaparib alone in recurrent platinum-sensitive ovarian cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32(5s):LBA5500.CrossRefGoogle Scholar
  31. 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 Off J Am Soc Clin Oncol. 2001;19(4):1001–7. PubMed PMID: 11181662CrossRefGoogle Scholar
  32. 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. PubMed PMID: 23576485. Pubmed Central PMCID: 3639527CrossRefPubMedPubMedCentralGoogle Scholar
  33. Moore KN, Reid MS, Fong DN, Myers TK, Landrum LM, Moxley KM, et al. Ovarian cancer in the octogenarian: does the paradigm of aggressive cytoreductive surgery and chemotherapy still apply? Gynecol Oncol. 2008;110(2):133–9. PubMed PMID: 18495221CrossRefPubMedGoogle Scholar
  34. 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. PubMed PMID: 22313338CrossRefPubMedGoogle Scholar
  35. Pallis AG, Hatse S, Brouwers B, Pawelec G, Falandry C, Wedding U, et al. Evaluating the physiological reserves of older patients with cancer: the value of potential biomarkers of aging? J Geriatr Oncol. 2014;5(2):204–18. PubMed PMID: 24495695CrossRefPubMedGoogle Scholar
  36. Parmar MK, Ledermann JA, Colombo N, du Bois A, Delaloye JF, Kristensen GB, 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(9375):2099–106. PubMed PMID: 12826431CrossRefPubMedGoogle Scholar
  37. Participants P, Audisio RA, Pope D, Ramesh HS, Gennari R, van Leeuwen BL, 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(2):156–63. PubMed PMID: 18082416CrossRefGoogle Scholar
  38. Pfisterer J, Plante M, Vergote I, du Bois A, Hirte H, Lacave AJ, et al. 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 Off J Am Soc Clin Oncol. 2006;24(29):4699–707. PubMed PMID: 16966687CrossRefGoogle Scholar
  39. Pignata S, Ferrandina G, Scarfone G, Scollo P, Odicino F, Cormio 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(3):233–41. PubMed PMID: 19179095CrossRefPubMedGoogle Scholar
  40. 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. PubMed PMID: 24582486CrossRefPubMedGoogle Scholar
  41. Pope D, Ramesh H, Gennari R, Corsini G, Maffezzini M, Hoekstra HJ, et al. 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(4):189–97. PubMed PMID: 17531743CrossRefPubMedGoogle Scholar
  42. Pujade-Lauraine E, Wagner U, Aavall-Lundqvist E, Gebski V, Heywood M, Vasey PA, et al. Pegylated liposomal doxorubicin and carboplatin compared with paclitaxel and carboplatin for patients with platinum-sensitive ovarian cancer in late relapse. J Clin Oncol Off J Am Soc Clin Oncol. 2010;28(20):3323–9. PubMed PMID: 20498395CrossRefGoogle Scholar
  43. Tew WP, Lichtman SM. Ovarian cancer in older women. Semin Oncol. 2008;35(6):582–9. PubMed PMID: 19027462CrossRefPubMedGoogle Scholar
  44. 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 Off J Am Soc Clin Oncol. 2009;27(15s). abstr #5541Google Scholar
  45. Tew WP, Java J, Chi D, Menzin A, Lovecchio JL, Bookman MA, Lichtman SM. Treatment outcomes for older women with advanced ovarian cancer: results from a phase III clinical trial (GOG182). J Clin Oncol. 2010;28(15 suppl). abstr # 5030CrossRefGoogle Scholar
  46. Tew WP, Muss HB, Kimmick GG, Von Gruenigen VE, Lichtman SM. Breast and ovarian cancer in the older woman. J Clin Oncol Off J Am Soc Clin Oncol. 2014. PubMed PMID: 25071129Google Scholar
  47. 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. PubMed PMID: 21860281. Pubmed Central PMCID: 3173498CrossRefPubMedPubMedCentralGoogle Scholar
  48. 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 Off J Eur Soc Med Oncol ESMO. 2007;18(2):256–62. PubMed PMID: 17082510CrossRefGoogle Scholar
  49. 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. PubMed PMID: 23850170CrossRefPubMedGoogle Scholar
  50. Vercelli M, Capocaccia R, Quaglia A, Casella C, Puppo A, Coebergh JW. Relative survival in elderly European cancer patients: evidence for health care inequalities. The EUROCARE Working Group. Crit Rev Oncol Hematol. 2000;35(3):161–79.CrossRefPubMedGoogle Scholar
  51. 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. PubMed PMID: 20818904CrossRefPubMedGoogle Scholar
  52. Von Gruenigen VE, Huang HQ, Beumer JH, et al. Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer – an NRG oncology/Gynecologic Oncology Group study. Gynecol Oncol. 2017;144(3):459–67. PMID: 28089376CrossRefGoogle Scholar
  53. Wimberger P, Lehmann N, Kimmig R, Burges A, Meier W, Hoppenau B, et al. Impact of age on outcome in patients with advanced ovarian cancer treated within a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol. 2006;100(2):300–7. PubMed PMID: 16199079CrossRefPubMedGoogle Scholar
  54. Won E, Hurria A, Feng T, Mohile S, Owusu C, Klepin HD, et al. CA125 level association with chemotherapy toxicity and functional status in older women with ovarian cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2013;23(6):1022–8. PubMed PMID: 23765208. Pubmed Central PMCID: 3772622CrossRefGoogle Scholar
  55. Wong H, Tang YF, Yao TJ, Chiu J, Leung R, Chan P, et al. The outcomes and safety of single-agent sorafenib in the treatment of elderly patients with advanced hepatocellular carcinoma (HCC). Oncologist. 2011;16(12):1721–8. PubMed PMID: 22135121. Pubmed Central PMCID: 3248771CrossRefPubMedPubMedCentralGoogle Scholar
  56. Wright JD, Ananth CV, Tsui J, Glied SA, Burke WM, Lu YS, et al. Comparative effectiveness of upfront treatment strategies in elderly women with ovarian cancer. Cancer. 2014;120(8):1246–54. PubMed PMID: 24443159. Pubmed Central PMCID: 4062652CrossRefPubMedPubMedCentralGoogle Scholar
  57. Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31(2):128–36. PubMed PMID: 15112144CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Icahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Memorial Sloan Kettering Cancer CenterNew YorkUSA

Section editors and affiliations

  • Etienne Brain
    • 1
  1. 1.Department of Medical Oncology, Institute CurieHôpital René HugueninSaint-CloudFrance

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