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Sia TY, Tew WP, Purdy C, Chi DS, Menzin AW, Lovecchio JL, Bookman MA, Cohn DE, Teoh DG, Friedlander M, Bender D, Mutch DG, Gershenson DM, Tewari KS, Wenham RM, Wahner Hendrickson AE, Lee RB, Gray HJ, Secord AA, Van Le L, Lichtman SM. The effect of older age on treatment outcomes in women with advanced ovarian cancer receiving chemotherapy: An NRG-Oncology/Gynecologic Oncology Group (GOG-0182-ICON5) ancillary study. Gynecol Oncol 2023; 173:130-137. [PMID: 37148580 PMCID: PMC10414765 DOI: 10.1016/j.ygyno.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/12/2023] [Accepted: 03/23/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To assess the effect of age on overall survival (OS) in women with ovarian cancer receiving chemotherapy. Secondary objectives were to describe the effect of age on treatment compliance, toxicities, progression free survival (PFS), time from surgery to chemotherapy, and rates of optimal cytoreduction. METHODS Women enrolled in GOG 0182-ICON5 with stage III or IV epithelial ovarian cancer (EOC) who underwent surgery and chemotherapy between 2001 and 2004 were included. Patients were divided into ages <70 and ≥ 70 years. Baseline characteristics, treatment compliance, toxicities, and clinical outcomes were compared. RESULTS We included a total of 3686 patients, with 620 patients (16.8%) ≥ 70 years. OS was 37.2 months in older compared to 45.0 months in younger patients (HR 1.21, 95% CI, 1.09-1.34, p < 0.001). Older patients had an increased risk of cancer-specific-death (HR 1.16, 95% CI, 1.04-1.29) as well as non-cancer related deaths (HR 2.78, 95% CI, 2.00-3.87). Median PFS was 15.1 months in older compared to 16.0 months in younger patients (HR 1.10, 95% CI, 1.00-1.20, p = 0.056). In the carboplatin/paclitaxel arm, older patients were just as likely to complete therapy and more likely to develop grade ≥ 2 peripheral neuropathy (35.7 vs 19.7%, p < 0.001). Risk of other toxicities remained equal between groups. CONCLUSIONS In women with advanced EOC receiving chemotherapy, age ≥ 70 was associated with shorter OS and cancer specific survival. Older patients receiving carboplatin and paclitaxel reported higher rates of grade ≥ 2 neuropathy but were not more likely to suffer from other chemotherapy related toxicities. Clintrials.gov: NCT00011986.
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Affiliation(s)
- Tiffany Y Sia
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - William P Tew
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Christopher Purdy
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Dennis S Chi
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Andrew W Menzin
- North Shore-Long Island Jewish Medical Center, Manhasset, NY, United States of America.
| | - John L Lovecchio
- North Shore-Long Island Jewish Medical Center, Manhasset, NY, United States of America.
| | - Michael A Bookman
- Gynecologic Oncology Therapeutics, Kaiser Permanente, San Francisco, CA, United States of America.
| | - David E Cohn
- Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America.
| | - Deanna G Teoh
- University of Minnesota Medical Center, Minneapolis, MN, United States of America.
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital and Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia.
| | - David Bender
- University of Iowa Hospitals, Iowa City, IA, United States of America.
| | - David G Mutch
- Washington University, St. Louis, MO, United States of America.
| | | | | | - Robert M Wenham
- Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America.
| | | | - Roger B Lee
- Tacoma General Hospital, Tacoma, WA, United States of America.
| | - Heidi J Gray
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America.
| | | | - Linda Van Le
- University of North Carolina, Chapel Hill, NC, United States of America.
| | - Stuart M Lichtman
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
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Abstract
Ovarian cancer is the third most common gynecologic malignancy worldwide but accounts for the highest mortality rate among these cancers. A stepwise approach to assessment, diagnosis, and treatment is vital to appropriate management of this disease process. An integrated approach with gynecologic oncologists as well as medical oncologists, pathologists, and radiologists is of paramount importance to improving outcomes. Surgical cytoreduction to R0 is the mainstay of treatment, followed by adjuvant chemotherapy. Genetic testing for gene mutations that affect treatment is the standard of care for all women with epithelial ovarian cancer. Nearly all women will have a recurrence, and the treatment of recurrent ovarian cancer continues to be nuanced and requires extensive review of up to date modalities that balance efficacy with the patient's quality of life. Maintenance therapy with poly ADP-ribose polymerase inhibitors, bevacizumab, and/or drugs targeting homologous recombination deficiency is becoming more widely used in the treatment of ovarian cancer, and the advancement of immunotherapy is further revolutionizing treatment targets.
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Affiliation(s)
- Lindsay Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO, USA
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Kim JS, Liang MI, Prendergast EN, Alldredge J, Datta A, Hurteau JA, Kirschner CV, Rodriguez G, Vogel TJ, Brooks RA, Cass I, Cohen JG, Penner KR, Wang CE, Diaz Moore ES. Clinical outcomes in ovarian cancer patients receiving three versus more cycles of chemotherapy after neoadjuvant treatment and interval cytoreductive surgery. Int J Gynecol Cancer 2019; 29:1156-1163. [PMID: 31352365 DOI: 10.1136/ijgc-2019-000374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To compare clinical outcomes for stage IIIC and IV ovarian cancer patients receiving neoadjuvant chemotherapy and interval cytoreductive surgery followed by up to three versus more cycles of post-operative chemotherapy. METHODS We conducted a multi-institution retrospective cohort study of patients treated from January 2005 to February 2016 with neoadjuvant platinum-based therapy followed by interval surgery and post-operative chemotherapy. The following were exclusion criteria: more than four cycles of neoadjuvant chemotherapy, bevacizumab with neoadjuvant chemotherapy, non-platinum therapy, prior chemotherapy, and elevated CA125 values after three post-operative chemotherapy cycles. Progression-free and overall survival and toxicity profiles were compared between groups receiving up to three cycles versus more that three cycles post-operatively. RESULTS A total of 100 patients met inclusion criteria: 41 received up to three cycles and 59 received more than three cycles. The groups were similar in terms of age, body mass index, performance status, tumor histology, optimal cytoreduction rates, and median number of neoadjuvant chemotherapy cycles. Median progression-free survival was 14 vs 16.6 months in those receiving up to three cycles versus more than three cycles, respectively (HR 0.99, 95% CI 0.58 to 1.68, p=0.97). Similarly, median overall survival was not different at 47.1 vs 69.4 months, respectively (HR 1.96, 95% CI 0.87 to 4.42, p=0.10). There were no differences in grade 2 or higher chemotherapy-related toxicities. CONCLUSIONS Extending post-operative chemotherapy beyond three cycles in patients receiving neoadjuvant chemotherapy and interval cytoreductive surgery with normalization of CA125 levels was not associated with improved survival or greater toxicity. Future study in a larger cohort is warranted to define optimal length of cytotoxic treatment.
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Affiliation(s)
- Josephine S Kim
- Section of Gynecologic Oncology, University of Chicago Medicine, Chicago, Illinois, USA .,Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Margaret I Liang
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Gynecologic Oncology, University of California Los Angeles, Los Angeles, California, USA
| | - Emily N Prendergast
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Gynecologic Oncology, University of California Los Angeles, Los Angeles, California, USA
| | - Jill Alldredge
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
| | - Avisek Datta
- Department of Biostatistics and Research Informatics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Jean A Hurteau
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Carolyn V Kirschner
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Gustavo Rodriguez
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Tilley J Vogel
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Rebecca A Brooks
- Section of Gynecologic Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Ilana Cass
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, University of California Los Angeles, Los Angeles, California, USA
| | - Kristine R Penner
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
| | - Chi E Wang
- Department of Biostatistics and Research Informatics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Elena S Diaz Moore
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
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Combination of Metformin and Chemotherapy Decreases the Recurrence Rates of Epithelial Ovarian Cancers: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.11621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gunderson CC, Moore KN. Olaparib: an oral PARP-1 and PARP-2 inhibitor with promising activity in ovarian cancer. Future Oncol 2015; 11:747-57. [PMID: 25757679 DOI: 10.2217/fon.14.313] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Olaparib (Lynparza™; AZD2281) is a potent PARP-1 and PARP-2 inhibitor with biologic activity in ovarian cancer as well as other solid tumors. It has been tested in Phase I and II trials and has single-agent activity in both germline BRCA mutated and sporadic ovarian cancer. Phase III trials assessing the efficacy of olaparib in the maintenance setting following first line and platinum-sensitive recurrence are underway for patients with a germline BRCA mutation, given the inherent molecular compatibility with the drug's mechanism of action.
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Affiliation(s)
- Camille C Gunderson
- University of Oklahoma Health Sciences Center, Stephenson Oklahoma Cancer Center, 800 NE 10th Street, Suite 5040, Oklahoma City, OK 73104, USA
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Qu JL, Li X, Qu XJ, Zhu ZT, Zhou LZ, Teng YE, Zhang JD, Jin B, Zhao MF, Yu P, Liu YP. Optimal duration of fluorouracil-based adjuvant chemotherapy for patients with resectable gastric cancer. PLoS One 2013; 8:e83196. [PMID: 24386161 PMCID: PMC3873471 DOI: 10.1371/journal.pone.0083196] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 11/10/2013] [Indexed: 11/23/2022] Open
Abstract
Background Although several clinical trials have suggested that postoperative adjuvant chemotherapy can improve survival of patients with gastric cancer, the optimal treatment duration has not been studied. This retrospective analysis evaluated the outcomes of patients with gastric cancer treated with six cycles of fluorouracil-based treatment compared with a cohort treated with four or eight cycles. Methods We retrospectively identified 237 patients with stage IB–IIIC gastric cancer who received four, six, or eight cycles of fluorouracil-based adjuvant chemotherapy administered every 3 weeks after radical gastrectomy. The endpoint was overall survival (OS). Factors associated with prognosis were also analyzed. Results The estimated 3-year OS rates for the four-, six-, and eight-cycle cohorts were 54.4%, 76.1%, and 68.9%, respectively; and the estimated 5-year OS rates were 41.2%, 74.0%, and 65.8%, respectively. Patients who received six cycles were more likely to have a better OS than those who received four cycles (P = 0.002). Eight cycles failed to show an additional survival benefit (P = 0.454). In the multivariate analysis, the number of chemotherapy cycles was associated with OS independent of clinical covariates (P<0.05). Subgroup analysis suggested that among patients in all age groups examined, male patients, and subgroups of fluorouracil plus oxaliplatin combined chemotherapy, stage III, poor differentiation, and gastrectomy with D2 lymphadenectomy, six cycles of adjuvant chemotherapy were associated with a statistically significant benefit of OS compared with four cycles (P<0.05). Conclusions Six cycles of adjuvant chemotherapy might lead to a favorable outcome for patients with gastric cancer, and two further cycles could not provide an additional clinical benefit.
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Affiliation(s)
- Jing-lei Qu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Xin Li
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Xiu-juan Qu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
- * E-mail: (YPL); (XJQ)
| | - Zhi-tu Zhu
- Department of Oncology, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, China
| | - Li-zhong Zhou
- Department of Medical Oncology, The Fourth Hospital of Anshan, Anshan, China
| | - Yue-e Teng
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Jing-dong Zhang
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Bo Jin
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Ming-fang Zhao
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Ping Yu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Yun-peng Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
- * E-mail: (YPL); (XJQ)
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Wagner U, Harter P, Hilpert F, Mahner S, Reuß A, du Bois A, Petru E, Meier W, Ortner P, König K, Lindel K, Grab D, Piso P, Ortmann O, Runnebaum I, Pfisterer J, Lüftner D, Frickhofen N, Grünwald F, Maier BO, Diebold J, Hauptmann S, Kommoss F, Emons G, Radeleff B, Gebhardt M, Arnold N, Calaminus G, Weisse I, Weis J, Sehouli J, Fink D, Burges A, Hasenburg A, Eggert C. S3-Guideline on Diagnostics, Therapy and Follow-up of Malignant Ovarian Tumours: Short version 1.0 - AWMF registration number: 032/035OL, June 2013. Geburtshilfe Frauenheilkd 2013; 73:874-889. [PMID: 24771937 PMCID: PMC3859160 DOI: 10.1055/s-0033-1350713] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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