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. 2017 Mar;144(3):459-467.
doi: 10.1016/j.ygyno.2016.11.033. Epub 2017 Jan 13.

Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer - An NRG oncology/Gynecologic Oncology Group study

Vivian E von Gruenigen  1 , Helen Q Huang  2 , Jan H Beumer  3 , Heather A Lankes  4 , William Tew  5 , Thomas Herzog  6 , Arti Hurria  7 , Robert S Mannel  8 , Tina Rizack  9 , Lisa M Landrum  10 , Peter G Rose  11 , Ritu Salani  12 , William H Bradley  13 , Thomas J Rutherford  14 , Robert V Higgins  15 , Angeles Alvarez Secord  16 , Gini Fleming  17
Affiliations

Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer - An NRG oncology/Gynecologic Oncology Group study

Vivian E von Gruenigen et al. Gynecol Oncol. 2017 Mar.

Abstract

Purpose: A simple measure to predict chemotherapy tolerance in elderly patients would be useful. We prospectively tested the association of baseline Instrumental Activities of Daily Living (IADL) score with ability to complete 4 cycles of first line chemotherapy without dose reductions or >7days delay in elderly ovarian cancer patients.

Patients and methods: Patients' age ≥70 along with their physicians chose between two regimens: CP (Carboplatin AUC 5, Paclitaxel 135mg/m2) or C (Carboplatin AUC 5), both given every 3weeks either after primary surgery or as neoadjuvant chemotherapy (NACT) with IADL and quality of life assessments performed at baseline, pre-cycle 3, and post-cycle 4.

Results: Two-hundred-twelve women were enrolled, 152 selecting CP and 60 selecting C. Those who selected CP had higher baseline IADL scores (p<0.001). After adjusting for age and PS, baseline IADL was independently associated with the choice of regimen (p=0.035). The baseline IADL score was not found to be associated with completion of 4 cycles of chemotherapy without dose reduction or delays (p=0.21), but was associated with completion of 4 cycles of chemotherapy regardless of dose reduction and delay (p=0.008) and toxicity, with the odds ratio (OR) of grade 3+ toxicity decreasing 17% (OR: 0.83; 95%CI: 0.72-0.96; p=0.013) for each additional activity in which the patient was independent. After adjustment for chemotherapy regimen, IADL was also associated with overall survival (p=0.019) for patients receiving CP.

Conclusion: Patients with a higher baseline IADL score (more independent) were more likely to complete 4 cycles of chemotherapy and less likely to experience grade 3 or higher toxicity.

Keywords: Chemotherapy; Elderly women; Ovarian cancer.

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Conflict of interest statement

CONFLICTS OF INTEREST

All other co-authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1
Completion status of four cycles of chemotherapy. Carboplatin Paclitaxel = CP, Carboplatin =P. Numbers equal %
Figure 2
Figure 2
Subgroup analysis of the association between other geriatric measures and tolerance of chemotherapy. Independent activities of daily living (IADL), activities of daily living (ADL), The Functional Assessment of Cancer Therapy — Ovary (FACT–O), body mass index (BMI).
Figure 3
Figure 3
Subgroup analysis of the association between geriatric measures and four cycles of chemotherapy regardless of dose reduction or treatment delay.
Figure 4
Figure 4
Patient reported PROs over Time by chemotherapy. Independent activities of daily living (IADL), activities of daily living (ADL), The Functional Assessment of Cancer Therapy — Ovary (FACT–O), Functional Assessment of Cancer Treatment — Neurotoxicity -FACT/GOG-Ntx 4 subscale
Figure 5
Figure 5
Overall Survival by number of Independent Instrumental Activities. Carboplatin Paclitaxel = CP, Carboplatin =P
See this image and copyright information in PMC

Comment in

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