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

• Published in: Gynecologic oncology 2017-03, Vol.144 (3), p.459-467
• Main Authors: von Gruenigen, Vivian E, Huang, Helen Q, Beumer, Jan H, Lankes, Heather A, Tew, William, Herzog, Thomas, Hurria, Arti, Mannel, Robert S, Rizack, Tina, Landrum, Lisa M, Rose, Peter G, Salani, Ritu, Bradley, William H, Rutherford, Thomas J, Higgins, Robert V, Secord, Angeles Alvarez, Fleming, Gini
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Elderly women; Fallopian Tube Neoplasms - drug therapy; Fallopian Tube Neoplasms - pathology; Female; Hematology, Oncology and Palliative Medicine; Humans; Obstetrics and Gynecology; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - pathology; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - pathology
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2016.11.033

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 > 7 days 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 135 mg/m2 ) or C (Carboplatin AUC 5), both given every 3 weeks 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.