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Merry E, Kesmez RT, Yu T, Flynn M, Ledermann J, Lockley M, Macdonald N, McCormack M, Nicum S, Crusz S, Miller R. A multicenter retrospective study to assess feasibility, safety and efficacy of first-line carboplatin-paclitaxel versus carboplatin monotherapy in a frail, elderly epithelial ovarian cancer population. Int J Gynecol Cancer 2024:ijgc-2024-005394. [PMID: 39231541 DOI: 10.1136/ijgc-2024-005394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
OBJECTIVE Underrepresentation of elderly ovarian cancer patients in clinical trials has led to lack of clarity regarding optimal first-line chemotherapy in this cohort. The Elderly Women with Ovarian Cancer (EWOC)-1 trial demonstrated that 3-weekly carboplatin (3wC) resulted in worse survival and feasibility compared with standard 3-weekly carboplatin-paclitaxel (3wCP) in frail, elderly ovarian cancer patients. Our retrospective study compares feasibility, safety, and efficacy of first-line 3wCP and 3wC in a frail ovarian cancer cohort. METHODS Clinical data were retrospectively analyzed for newly-diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV, ≥70-year-old epithelial ovarian cancer patients, treated by clinician choice with 3wC or 3wCP at two London cancer centers over a 2 year period. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status provided surrogate markers of frailty. Common Terminology Criteria for Adverse Events v5.0 graded toxicity. RESULTS A total of 107 patients were treated with 3wC (n=30) and 3wCP (n=77). Age, performance status, and CCI were significantly different between cohorts, with 3wC patients older (84 vs 75 years, p<0.001), with more comorbidities (median CCI 4 vs 3, p<0.001) and worse performance status (47% vs 17% PS ≥2, p=0.015). Surgical outcomes differed significantly between cohorts, with 20 (67%) 3wC patients not undergoing surgery, compared with 22 (29%) 3wCP patients (p<0.001). Median follow-up was 45.8 months (IQR 38.7-56.3 months). While we observed improved progression-free (HR 0.55, 95% CI 0.33 to 0.90, p=0.017) and overall survival (HR 0.44, 95% CI 0.27 to 0.73, p=0.001, log-rank test) in a univariate cox proportional hazards comparison between 3wCP and 3wC, this was not significant on multivariate analysis. Completion of six planned chemotherapy cycles was achieved by the majority, with similar discontinuation rates between groups (13% 3wC vs 8% 3wCP, p>0.05). Overall grade ≥3 hematological toxicity rates were similar between regimens (33% 3wC vs 44% 3wCP, p=0.37) with grade ≥3 neutropenia (p=0.019) and grade ≥3 thrombocytopenia (p=0.006) more common with 3wCP and 3wC, respectively. No treatment-related deaths occurred. CONCLUSION Our data demonstrates that standard 3wCP is a well-tolerated, feasible first-line treatment for frail, elderly ovarian cancer patients. Improved survival with 3wCP was not significant when corrected for established clinical prognostic factors.
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Affiliation(s)
- Eve Merry
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Tamara Yu
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael Flynn
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Ledermann
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- UCL Cancer Institute, London, UK
| | - Michelle Lockley
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- Bart's Cancer Institute, Queen Mary University of London, London, UK
| | - Nicola Macdonald
- Gynaecological Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary McCormack
- Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shibani Nicum
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Rowan Miller
- Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- Medical Oncology, Barts Health NHS Trust, London, UK
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Rousseau F, Ranchon F, Bardin C, Bakrin N, Lavoué V, Bengrine-Lefevre L, Falandry C. Ovarian cancer in the older patient: where are we now? What to do next? Ther Adv Med Oncol 2023; 15:17588359231192397. [PMID: 37724138 PMCID: PMC10505350 DOI: 10.1177/17588359231192397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/19/2023] [Indexed: 09/20/2023] Open
Abstract
In recent years, major advances have been made toward the individualization of epithelial ovarian cancer care, leading to an overall improvement of patient outcomes. However, real-life data indicate that the oldest populations do not benefit from this, due to aspects related to cancer (more aggressive histopathological features), treatment (i.e. frequently suboptimal), and the host (increased toxicities in patients with lower physiological reserve). A specific risk-benefit perspective should therefore be taken when considering surgery, chemotherapy, and maintenance treatments: the decision for cytoreductive surgery should include geriatric vulnerability and surgical complexity, neo-adjuvant chemotherapy being an option when primary surgery appears at high risk; carboplatin paclitaxel association remains the standard even in vulnerable older patients; and bevacizumab and poly(ADP-ribose) polymerase inhibitors maintenance are interesting options provided they are prescribed according to their indications with a close monitoring of their toxicities. Future studies should aim to individualize care without limiting access of older patients to innovation. A specific focus is needed on age-specific translational analyses (focusing on tumor mutational burden and impaired biological pathways), a better patient stratification according to geriatric parameters, an adaptation of both oncological treatment and geriatric interventions, and treatment adaptations not a priori but according to formal pharmacokinetic data.
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Affiliation(s)
- Frédérique Rousseau
- Institut Paoli Calmettes Institute, Marseille, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Florence Ranchon
- Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Hospices Civils de Lyon, Pierre-Bénite, France
- CICLY Centre pour l’Innovation en Cancérologie de Lyon, Oullins, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Christophe Bardin
- Service de Pharmacie Clinique, Hôpital Cochin AP-HP Centre Université Paris Cité, Paris, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Naoual Bakrin
- Hospices Civils de Lyon, Service de Chirurgie Digestive, CHU Hôpital Lyon-Sud, Pierre-Bénite Cedex, France
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Vincent Lavoué
- Service de Gynécologie, CHU de Rennes, Hôpital Sud, Rennes, France
- UMR S1085, IRSET-INSERM, Université de Rennes, Rennes, France
- Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN)
| | - Leila Bengrine-Lefevre
- Département d’Oncologie Médicale, Centre Georges-Francois Leclerc, Dijon, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Claire Falandry
- Hospices Civils de Lyon, Unité de Gériatrie, Centre Hospitalier de la Croix Rousse, 103, Grande Rue de la Croix-Rousse, Lyon 69004, France
- Université de Lyon, CarMeN Laboratory, INSERM U.1060/Université Lyon 1/INRA U1397/INSA Lyon/Hospices Civils Lyon Bâtiment CENS-ELI 2D; Hôpital Lyon Sud Secteur 2; Pierre-Bénite 69310, France
- Université Claude Bernard Lyon 1, Pierre-Bénite 69310, France Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
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Multi-Disciplinary Care Planning of Ovarian Cancer in Older Patients: General Statement-A Position Paper from SOFOG-GINECO-FRANCOGYN-SFPO. Cancers (Basel) 2022; 14:cancers14051295. [PMID: 35267603 PMCID: PMC8909025 DOI: 10.3390/cancers14051295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary This position paper aims to provide practitioners a proposal for multidisciplinary care planning for older patients with ovarian cancer from the time of suspected diagnosis. The first-line treatment of advanced ovarian cancer involves several interdependent sequences: cytoreductive surgery, (neo)adjuvant chemotherapy and maintenance targeted treatments. In older patients, care planning must be adapted to their geriatric parameters and consider the geriatric impact of each treatment sequence to allow treatment completion. Care planning should be centered on patient motivation and imply multidisciplinarity. Each step of treatment plan should be reconsidered in light of a geriatric assessment and follow-up. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes. Abstract In this position paper the Société Francophone d’OncoGériatrie (SOFOG; French-speaking oncogeriatric society), the Société Française de Pharmacie Oncologique (SFPO, French society for oncology pharmacy), the Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO, National Investigators’ Group for Studies in Ovarian and Breast Cancer) and the Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN) propose a multi-disciplinary care planning of ovarian cancer in older patients. The treatment pathway is based on four successive decisional nodes (diagnosis, resectability assessment, operability assessment, adjuvant, and maintenance treatment decision) implying multidisciplinarity and adaptation of the treatment plan according to the patient’s geriatric covariates and her motivation towards treatment. Specific attention must be paid to geriatric intervention, supportive care and pharmaceutical conciliation. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes.
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Falandry C, Pommeret F, Gladieff L, Tinquaut F, Lorusso D, Mouret-Reynier MA, D'Hondt V, Mollon-Grange D, Floquet A, Abadie-Lacourtoisie S, Brachet PE, Stefani L, Rousseau F, Frenel JS, Del Piano F, Komulainen M, Warkus T, Trédan O, Pujade-Lauraine E, Freyer G. Validation of the geriatric vulnerability score in older patients with ovarian cancer: an analysis from the GCIG-ENGOT-GINECO EWOC-1 study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e176-e185. [PMID: 36098291 DOI: 10.1016/s2666-7568(22)00002-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Older patients with ovarian cancer represent a heterogeneous population. The French National Group of Investigators for the Study of Ovarian and Breast Cancer developed the geriatric vulnerability score (GVS) to identify geriatric parameters predictive of poor outcomes. A prospective validation of the GVS was needed. METHODS The EWOC-1 study (NCT02001272) was an international, open-label, phase 2, three-arm trial designed according to a two-step process. Patients aged 70 years or older with newly diagnosed stage III or IV ovarian cancer were identified and the GVS determined. Those with a GVS of 3 or greater were randomly assigned to the EWOC-1 trial, stratified by country and surgical outcome, to receive three different carboplatin with or without paclitaxel regimens; those not included in the EWOC-1 trial were followed up in the EWOC-1 registry. External validation of the GVS was a secondary endpoint of the trial. Three validation cohorts were identified: the total population (validation cohort 1 [V1], n=447), the registry-only population (validation cohort 2 [V2], n=327), and the carboplatin-paclitaxel-treated population (validation cohort 3 [V3], n=320). FINDINGS From Dec 11, 2013, to Nov 16, 2018, 447 patients were included in 48 academic centres in six countries; 120 in the EWOC-1 trial and 327 in the EWOC-1 registry. Median follow-up was 19·7 (95% CI 8·5-29·7) months for the total cohort; missing values were low (<2%). According to the maximum likelihood analysis, the hazard ratio (HR) of death in V1 was 1·8 (95% CI 1·1-3·1, p=0·029) for those with a GVS of 1; 2·4 (1·4-4·0, p=0·0009) with a GVS of 2; 4·1 (2·5-7·0, p<0·0001) for a GVS of 3; 5·5 (3·3-9·3, p<0·0001) for a GVS of 4; and 9·1 (4·7-17·5, p<0·0001) for a GVS of 5 compared with a score of 0. Whatever the validation cohort, GVS of 3 or more significantly segregated two groups with different overall survival: V1 (median 13·2 [95% CI: 10·8-18·7] vs 40·8 [32·0-45·6] months; HR 2·8 [95% CI 2·2-3·7]; p<0·0001); V2 (11·9 [95% CI 8·8-18·1] vs 40·8 [32·0-45·6] months, HR 3·5 [2·5-4·9]; p<0·0001); and V3 (18·1 [95% CI 15·8-31·8] vs 43·0 [40·6-49·7] months, HR 2·6 [1·9 to 3·7]; p<0·0001). INTERPRETATION The GVS has high prognostic performance for overall survival in patients with advanced ovarian cancer, independently of geographic and historic effect (V1), as well as treatment patterns (V3), validated in an international population. Even though the GVS is time consuming it will allow the stratification of populations for clinical research and might permit the orientation of the geriatric intervention to specific domains. FUNDING French National Cancer Institute. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Claire Falandry
- GINECO, Paris, France; Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
| | - Fanny Pommeret
- GINECO, Paris, France; Institut Gustave Roussy, Villejuif, France
| | - Laurence Gladieff
- GINECO, Paris, France; Institut Claudius Regaud-IUCT Oncopole, Toulouse, France
| | - Fabien Tinquaut
- GINECO, Paris, France; Institut de Cancérologie de la Loire, St Priest en Jarez, France
| | - Domenica Lorusso
- MITO and IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Véronique D'Hondt
- GINECO, Paris, France; Institut du Cancer de Montpellier, Montpellier, France
| | | | - Anne Floquet
- GINECO, Paris, France; Institut Bergonié, Bordeaux, France
| | | | | | - Laetitia Stefani
- GINECO, Paris, France; Centre Hospitalier Annecy Genevois, Pringy, France
| | | | - Jean-Sébastien Frenel
- GINECO, Paris, France; Institut de Cancérologie de l'Ouest-site René Gauducheau, Nantes, France
| | | | | | | | | | | | - Gilles Freyer
- GINECO, Paris, France; Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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Concin N, Planchamp F, Abu-Rustum NR, Ataseven B, Cibula D, Fagotti A, Fotopoulou C, Knapp P, Marth C, Morice P, Querleu D, Sehouli J, Stepanyan A, Taskiran C, Vergote I, Wimberger P, Zapardiel I, Persson J. European Society of Gynaecological Oncology quality indicators for the surgical treatment of endometrial carcinoma. Int J Gynecol Cancer 2021; 31:1508-1529. [PMID: 34795020 DOI: 10.1136/ijgc-2021-003178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Quality of surgical care as a crucial component of a comprehensive multi-disciplinary management improves outcomes in patients with endometrial carcinoma, notably helping to avoid suboptimal surgical treatment. Quality indicators (QIs) enable healthcare professionals to measure their clinical management with regard to ideal standards of care. OBJECTIVE In order to complete its set of QIs for the surgical management of gynecological cancers, the European Society of Gynaecological Oncology (ESGO) initiated the development of QIs for the surgical treatment of endometrial carcinoma. METHODS QIs were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for the identification of potential QIs and documentation of the scientific evidence, two consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians and patient representatives. QIs were defined using a structured format comprising metrics specifications, and targets. A scoring system was then developed to ensure applicability and feasibility of a future ESGO accreditation process based on these QIs for endometrial carcinoma surgery and support any institutional or governmental quality assurance programs. RESULTS Twenty-nine structural, process and outcome indicators were defined. QIs 1-5 are general indicators related to center case load, training, experience of the surgeon, structured multi-disciplinarity of the team and active participation in clinical research. QIs 6 and 7 are related to the adequate pre-operative investigations. QIs 8-22 are related to peri-operative standards of care. QI 23 is related to molecular markers for endometrial carcinoma diagnosis and as determinants for treatment decisions. QI 24 addresses the compliance of management of patients after primary surgical treatment with the standards of care. QIs 25-29 highlight the need for a systematic assessment of surgical morbidity and oncologic outcome as well as standardized and comprehensive documentation of surgical and pathological elements. Each QI was associated with a score. An assessment form including a scoring system was built as basis for ESGO accreditation of centers for endometrial cancer surgery.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria .,Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | | | - Nadeem R Abu-Rustum
- Department of Obstetrics and Gynecology, Memorial Sloann Kettering Cancer Center, New York, New York, USA
| | - Beyhan Ataseven
- Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynaecology, University Hospital Munich (LMU), Munich, Germany
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | - Pawel Knapp
- Department of Gynaecology and Gynaecologic Oncology, University Oncology Center of Bialystok, Medical University of Bialystok, Bialystok, Poland
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Artem Stepanyan
- Department of Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Ankara, Turkey.,Department of Gynecologic Oncology, VKV American Hospital, Istambul, Turkey
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Jan Persson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.,Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
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Ecarnot F, Meunier-Beillard N, Quenot JP, Meneveau N. Factors associated with refusal or acceptance of older patients (≥ 65 years) to provide consent to participate in clinical research in cardiology: a qualitative study. Aging Clin Exp Res 2020; 32:133-140. [PMID: 30903598 DOI: 10.1007/s40520-019-01172-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical research is an essential step in the successful translation of knowledge from basic research into concrete clinical applications, yet many people are reluctant to provide consent when actually approached to actively participate in clinical trials. AIMS We investigated the factors that influence older patient's (≥ 65 years) decisions to accept or refuse to participate in a prospective randomized clinical trial in secondary prevention after acute coronary syndrome. METHODS Qualitative approach based on individual semi-structured interviews with patients who were approached for consent to participate in a currently ongoing clinical trial was adopted. Patients were interviewed after the consent process (8 accepted; 8 refused the trial). Interviews were analysed using grounded theory methodology. RESULTS Sixteen patients aged ≥ 65 years participated. The main concept to emerge from these interviews is that the actual trial itself does not appear to be the primary determinant in the decision to participate in clinical research. Rather, patients' decisions to participate (or not) in clinical research appear to be primarily determined by their capacity to deal with the current health event that has disrupted their life, and by their available mental and physical resources. DISCUSSION AND CONCLUSION Older patients display varying levels of engagement in their own health, ranging from low engagement with high trust in the medical profession, to high engagement mirrored by distrust of the medical profession. Structural conditions, such as personal benefit from trial participation, or logistic barriers to participation, seem to affect both accepters and refusers in the same manner.
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Affiliation(s)
- Fiona Ecarnot
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, University of Franche-Comté, 3 Boulevard Fleming, 25000, Besançon, France.
| | - Nicolas Meunier-Beillard
- Unité de Soutien Méthodologique à la Recherche - Délégation à la Recherche Clinique et à l'Innovation, François Mitterand University Hospital, Dijon, France
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, 14 rue Paul Gaffarel, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, University of Franche-Comté, 3 Boulevard Fleming, 25000, Besançon, France
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Early treatment modifications improve chemotherapy adherence in ovarian cancer patients ≥70 years. Gynecol Oncol 2019; 153:616-624. [PMID: 30905433 DOI: 10.1016/j.ygyno.2019.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Elderly ovarian cancer patients are underrepresented in clinical trials and disadvantaged with regard to therapeutic standards compared to other age groups. We explored the specific performance of a subset of patients aged ≥70 years in a large meta-data set of 3 phase III trials. METHODS 3333 patients with advanced ovarian cancer recruited into 3 clinical phase III trials of the AGO & GINECO study groups were retrospectively analysed for age-specific prognostic and toxicity parameters. RESULTS Only 10% (359/3333) of the patients were aged ≥70 years. This subgroup presented with impaired performance statuses (ECOG 2 14.8 vs 10.1%) and higher FIGO-stages (FIGO IIIC-IV 78.5 vs 73.6%) compared to younger patients. Complete operative tumor resection was achieved less frequently (postoperative tumor burden >10 mm 46.7 vs 33.9%) and elderly received less cycles of platinum/taxane-based chemotherapies (>4 cycles 81.9 vs 90.7%). FIGO-stage, histology, postoperative tumor burden and number of chemotherapy cycles were independent prognostic factors in elderly patients. Elderly patients with ≤4 cycles of chemotherapy showed a median OS of 18.4 months compared to 30.9 months in elderly with 5-6 cycles (p < 0.001). This effect was accentuated in elderly patients after complete tumor resection (cumulative survival benefit of 33.8 months). Analyses of chemotherapeutic delivery revealed that elderly patients with at least one cycle delay had higher chances to complete >4 cycles of chemotherapy. CONCLUSIONS Protocol defined treatment modifications might support completion of >4 cycles of standard chemotherapy in fit elderly OC patients.
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Prince RM, Powis M, Zer A, Atenafu EG, Krzyzanowska MK. Hospitalisations and emergency department visits in cancer patients receiving systemic therapy: Systematic review and meta-analysis. Eur J Cancer Care (Engl) 2018; 28:e12909. [DOI: 10.1111/ecc.12909] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/05/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Rebecca M. Prince
- Princess Margaret Cancer Centre; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Melanie Powis
- Princess Margaret Cancer Centre; Toronto Ontario Canada
| | - Alona Zer
- Davidoff Cancer Center; Rabin Medical Center; Tel Aviv Israel
- Tel Aviv University; Tel Aviv Israel
| | - Eshetu G. Atenafu
- Princess Margaret Cancer Centre; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
| | - Monika K. Krzyzanowska
- Princess Margaret Cancer Centre; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
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9
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Participation of elderly gynecological cancer patients in clinical trials. Arch Gynecol Obstet 2018; 298:797-804. [DOI: 10.1007/s00404-018-4886-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/24/2018] [Indexed: 01/04/2023]
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10
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Sorio R, Roemer-Becuwe C, Hilpert F, Gibbs E, García Y, Kaern J, Huizing M, Witteveen P, Zagouri F, Coeffic D, Lück HJ, González-Martín A, Kristensen G, Levaché CB, Lee CK, Gebski V, Pujade-Lauraine E. Safety and efficacy of single-agent bevacizumab-containing therapy in elderly patients with platinum-resistant recurrent ovarian cancer: Subgroup analysis of the randomised phase III AURELIA trial. Gynecol Oncol 2017; 144:65-71. [DOI: 10.1016/j.ygyno.2016.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
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Grabowski JP, Harter P, Heitz F, Pujade-Lauraine E, Reuss A, Kristensen G, Ray-Coquard I, Heitz J, Traut A, Pfisterer J, du Bois A. Operability and chemotherapy responsiveness in advanced low-grade serous ovarian cancer. An analysis of the AGO Study Group metadatabase. Gynecol Oncol 2016; 140:457-62. [PMID: 26807488 DOI: 10.1016/j.ygyno.2016.01.022] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Since almost two decades standard 1st-line chemotherapy for advanced ovarian cancer (AOC) has been a platinum/taxane combination. More recently, this general strategy has been challenged because different types of AOC may not benefit homogenously. Low-grade serous ovarian cancer (LGSOC) is one of the candidates in whom efficacy of standard chemotherapy should be revised. METHODS This study is an exploratory case control study of the AGO-metadatabase of 4 randomized phase III trials with first-line platinum combination chemotherapy without any targeted therapy. Patients with advanced FIGO IIIBIV low-grade serous ovarian cancer were included and compared with control cases having high-grade serous AOC. RESULTS Out of 5114 patients in this AGO database 145 (2.8%) had LGSOC and of those thirty-nine (24.1%) had suboptimal debulking with post-operative residual tumor >1cm, thus being eligible for response evaluation. An objective response was observed in only 10 patients and this 23.1% response rate (RR) was significantly lower compared to 90.1% RR in the control cohort of high-grade serous ovarian cancer (HGSOC) (p<0.001). Both, LGSOC and HGSOC patients who underwent complete cytoreduction had significantly better progression free survival (PFS) and overall survival (OS) in comparison to those with residuals after primary surgery, accordingly (p<0.001). CONCLUSIONS Our observation indicates that low-grade serous cancer is not as responsive to platinum-taxane-based chemotherapy as high-grade serous AOC. In contrast, surgical debulking showed a similar impact on outcome in both types of AOC thus indicating different roles for both standard treatment modalities. Systemic treatment of low grade serous AOC urgently warrants further investigations.
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Affiliation(s)
- Jacek P Grabowski
- Department of Gynecology and Gynecological Oncology, Kliniken Essen Mitte, Henricistrasse 92, 45136 Essen, Germany; Department of Gynecology, European Competence Center for Ovarian Cancer, Charite-University Medicine of Berlin, Augustenberger Platz 1, 13353 Berlin, Germany.
| | - Philipp Harter
- Department of Gynecology and Gynecological Oncology, Kliniken Essen Mitte, Henricistrasse 92, 45136 Essen, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecological Oncology, Kliniken Essen Mitte, Henricistrasse 92, 45136 Essen, Germany
| | - Eric Pujade-Lauraine
- Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Oncology Department, Universite Paris Descartes, AP-HP, Hopitaux Universitaires Paris Centre, Site Hotel Dieu, Paris, France
| | - Alexander Reuss
- Koordinierungszentrum fuer Klinische Studien, Philipps-Universitaet Marburg, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany
| | - Gunnar Kristensen
- Nordic Society of Gynaecological Oncology Group (NSGO), Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo University Hospital, PB4953 Nydalen, 0424 Oslo, Norway
| | - Isabelle Ray-Coquard
- Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Université de Lyon-Centre Léon Bérard, Department of Medical Oncology and EA SIS, 4128 Lyon, France
| | - Julia Heitz
- Department of Gynecology and Obstetrics, Klinikum Duisburg, Zu den Rehwiesen 9-11, 47055 Duisburg, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecological Oncology, Kliniken Essen Mitte, Henricistrasse 92, 45136 Essen, Germany
| | - Jacobus Pfisterer
- Gynecologic Oncology Center, Kiel, Herzog-Friedrich-Str. 21, 24103 Kiel, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecological Oncology, Kliniken Essen Mitte, Henricistrasse 92, 45136 Essen, Germany
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12
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Harter P, Johnson T, Berton-Rigaud D, Park SY, Friedlander M, Del Campo JM, Shimada M, Forget F, Mirza MR, Colombo N, Zamagni C, Chan JK, Imhof M, Herzog TJ, O'Donnell D, Heitz F, King K, Stinnett S, Barrett C, Jobanputra M, Xu CF, du Bois A. BRCA1/2 mutations associated with progression-free survival in ovarian cancer patients in the AGO-OVAR 16 study. Gynecol Oncol 2015; 140:443-9. [PMID: 26740259 DOI: 10.1016/j.ygyno.2015.12.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/17/2015] [Accepted: 12/25/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE AGO-OVAR 16 demonstrated that pazopanib maintenance therapy significantly increased progression-free survival (PFS) in patients with ovarian cancer whose disease had not progressed after first-line therapy. In a sub-study, we evaluated the effect of clinically important germline BRCA1 and BRCA2 mutations on PFS. METHODS Of 940 AGO-OVAR 16 participants, 664 had BRCA1/2 exon sequencing data (pazopanib, n=335; placebo, n=329). A Cox model was used to test the association between genetic variants and PFS. RESULTS Ninety-seven of 664 patients (15%) carried clinically important BRCA1/2 mutations (BRCA1/2 carriers: pazopanib 14%, placebo 16%). Median PFS was longer in BRCA1/2 mutation carriers than in BRCA1/2 non-carriers in the placebo arm (30.3 vs 14.1 months, hazard ratio, 0.48; 95% confidence interval [CI]: 0.29-0.78; P=0.0031); a similar non-significant trend was noted with pazopanib (30.2 vs 17.7 months, hazard ratio, 0.64; 95% CI: 0.40-1.03; P=0.069). Among BRCA1/2 non-carriers, PFS was longer for pazopanib-treated patients than placebo-treated patients (17.7 vs 14.1 months, hazard ratio, 0.77; 95% CI: 0.62-0.97; P=0.024). Among BRCA1/2 carriers, there was no significant PFS difference between treatments, although numbers were small (pazopanib, 46; placebo, 51), resulting in a wide CI (hazard ratio, 1.36; 95% CI: 0.66-2.82). CONCLUSIONS Patients with clinically important BRCA1/2 mutations had better prognosis. BRCA1/2 mutation status might be added as strata in future trials in primary ovarian cancer.
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Affiliation(s)
- Philipp Harter
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany.
| | - Toby Johnson
- GlaxoSmithKline, Gunnels Wood Road, Stevenage SG1 2NY, UK
| | | | | | - Michael Friedlander
- The Prince of Wales Clinical School University of New South Wales, Randwick, NSW, Australia
| | - Josep M Del Campo
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishimachi, Yonago, Japan
| | | | | | - Nicoletta Colombo
- Gynecologic Oncology, University of Milan-Bicocca and European Institute of Oncology, Milan, Italy
| | | | - John K Chan
- California Pacific and Palo Alto Sutter Cancer Research Institute, San Francisco, CA, USA
| | - Martin Imhof
- Regional Hospital Korneuburg, Medical University of Vienna, Austria
| | - Thomas J Herzog
- University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | | | - Florian Heitz
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany
| | | | | | | | | | - Chun-Fang Xu
- GlaxoSmithKline, Gunnels Wood Road, Stevenage SG1 2NY, UK
| | - Andreas du Bois
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany
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Bernard-Davila B, Aycinena AC, Richardson J, Gaffney AO, Koch P, Contento I, Molmenti CS, Alvarez M, Hershman D, Greenlee H. Barriers and facilitators to recruitment to a culturally-based dietary intervention among urban Hispanic breast cancer survivors. J Racial Ethn Health Disparities 2015; 2:244-55. [PMID: 26557471 PMCID: PMC4636022 DOI: 10.1007/s40615-014-0076-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to understand factors related to recruitment to behavioral intervention trials among Spanish-speaking urban Hispanic breast cancer (BC) survivors. METHODS Potentially eligible Hispanic BC survivors were recruited from the Columbia University Breast Oncology Clinic, signed informed consent, and completed a screening interview on demographics, medical history, acculturation (Short Acculturation Scale for Hispanics), quality of life (QOL), and perceived benefits/risks of research participation. Trial eligibility criteria included stage 0-III BC, completion of adjuvant treatment, Hispanic, fluency in Spanish, willing to be randomized to active arm (9-session in-person culturally-based ¡Cocinar para su salud! dietary modification program) or control arm (written materials). We compared characteristics between eligible women who did and did not enroll in the trial. RESULTS 102 women completed the screening interview and were eligible to participate. Overall mean age was 57.3 ± 9.5 years, mean time since diagnosis was 3.4 ± 2.1 years, 71% reported annual household income <$15,000 and mean acculturation index score was 1.6 ± 0.6 (scale 1-5, low-high). Of the 102 women, 70 enrolled and 32 declined participation. Reasons stated for non-participation included lack of interest in dietary change, illness, and work constraints. Compared to women who enrolled, women who did not enroll were less likely to be employed (P=0.03) and more likely to only read/speak Spanish (P=0.02). Compared to women who enrolled, non-enrollers were more likely to state that research is costly to participants (P=0.03). CONCLUSION Lower participation was associated with unemployment, monolingualism, and the perception that research is costly to participants. Future behavioral intervention trials among minority BC survivors need to account for these and other factors that may be related to trial participation.
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Affiliation(s)
- Blanca Bernard-Davila
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - A. Corina Aycinena
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY; Columbia University, New York, NY
| | - John Richardson
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | | | - Pam Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY; Columbia University, New York, NY
| | - Isobel Contento
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY; Columbia University, New York, NY
| | - Christine Sardo Molmenti
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Maria Alvarez
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Dawn Hershman
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Heather Greenlee
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
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Manders DB, Paulsen A, Richardson DL, Kehoe SM, Miller DS, Lea JS. Factors associated with clinical trial screening failures in gynecologic oncology. Gynecol Oncol 2014; 134:450-4. [DOI: 10.1016/j.ygyno.2014.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 12/26/2022]
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16
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Nivison-Smith I, Simpson JM, Dodds AJ, Ma DDF, Szer J, Bradstock KF. A population-based analysis of the effect of autologous hematopoietic cell transplant in the treatment of multiple myeloma. Leuk Lymphoma 2013; 54:1671-6. [PMID: 23286335 DOI: 10.3109/10428194.2013.763396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This population registry-based study followed all cases of myeloma diagnosed in New South Wales, Australia, during 2002-2005 and compared survival outcomes of those who proceeded to autologous hematopoietic cell transplant (HCT) with those who did not. Data available consisted of demographic details and survival, and did not include disease details or treatment type or response. Of 708 patients, 270 (38%) had a HCT. The 5-year overall survival (OS) of HCT recipients was significantly better than for those who did not proceed to HCT (62% vs. 54%, p = 0.003). HCT was a significant favorable risk factor for OS, while age over 60 was an adverse risk factor. However, for patients alive at 1 year from diagnosis, there was no significant difference in survival between HCT and non-HCT patients, suggesting that worse disease biology and/or coexisting morbidities were likely to be major reasons for the poorer outcome for non-HCT patients.
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Affiliation(s)
- Ian Nivison-Smith
- Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Darlinghurst, NSW, Australia.
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Mahner S, Oskay-Özcelik G, Heidrich-Lorsbach E, Fuxius S, Sommer H, Klare P, Belau A, Ruhmland B, Heuser T, Kölbl H, Markmann S, Sehouli J. A prospective multicenter study of treosulfan in elderly patients with recurrent ovarian cancer: results of a planned safety analysis. J Cancer Res Clin Oncol 2012; 138:1413-9. [PMID: 22526159 PMCID: PMC3397225 DOI: 10.1007/s00432-012-1221-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 03/29/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treosulfan, an alkylating agent, has demonstrated activity in recurrent ovarian carcinoma. It is equieffective as oral (p.o.) and intravenous (i.v.) formulation. To explore the preference and compliance of elderly patients regarding p.o. or i.v. treosulfan for the treatment of relapsed ovarian carcinoma, women aged 65 years or older were included in this prospective multicenter study. Since elderly patients usually have several concomitant diseases and experience more treatment toxicity, an interim safety analysis was planned and performed after 25 patients finished therapy to assess the tolerability of the treatment regimens. METHODS Patients had a free choice of treosulfan i.v. (7,000 mg/m(2) day 1 of a 28-day cycle) or p.o. (600 mg/m(2) day 1-28 of a 56-day cycle) for a maximum of 12 cycles (i.v.) or 12 months (p.o.). Indecisive patients were randomized. Toxicity was evaluated according to the NCI-CTC version 2.0. RESULTS Twenty-five of 51 recruited patients completed therapy at the time of the planned interim analysis (median age, 75 years; range, 70-82). Median ECOG was 1, and median number of prior chemotherapy regimens was 2. A median number of 4 cycles (range, 1-12) were administered per patient. Anemia was the most common hematological toxicity (88 % of patients). Most frequent non-hematological toxicities were nausea (76 %), constipation (68 %), and fatigue (64 %). CONCLUSION Treatment was generally well tolerated despite the fact that most patients suffered from multiple comorbidities and were heavily pretreated. There were no unexpected hematological or non-hematological toxicities. Based on this safety analysis, the next step of study recruitment was continued.
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Affiliation(s)
- Sven Mahner
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Hilpert F, Wimberger P, du Bois A, Pfisterer J, Harter P. Treatment of Elderly Ovarian Cancer Patients in the Context of Controlled Clinical Trials: A Joint Analysis of the AGO Germany Experience. ACTA ACUST UNITED AC 2012; 35:76-81. [DOI: 10.1159/000336829] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Management of the Elderly Patient With Gynecologic Cancer: Report of the 2011 Workshop in Geriatric Gynecologic Oncology. Int J Gynecol Cancer 2012; 22:161-9. [DOI: 10.1097/igc.0b013e318234f8d5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AbstractReflecting the worldwide aging trend and close association of aging with cancer, geriatric oncology is now growing beyond its pioneer years. Nevertheless, geriatric oncology in the gynecologic field is in the beginning stage; indeed, there is no geriatric specialist who is trained in this particular field of gynecologic oncology. Therefore, we held the first workshop in geriatric gynecologic oncology. In this review, we summarize what we discussed at the workshop and provide evidence-based recommendations for the diagnosis and treatment of gynecologic cancer in elderly individuals.
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Abstract
Elderly patients are more commonly diagnosed with advanced ovarian cancer and represent a growing proportion of all ovarian cancer cases. Despite this, the elderly have historically been underrepresented in clinical trials. Because clinical trials form the basis for most treatment guidelines and the elderly have been, to date, largely excluded from this process, little is known about the appropriate assessment and treatment of elderly ovarian cancer patients. Recognizing this knowledge deficit and the pressing need to correct it, this article aimed to summarize existing data and identify future areas of research focus.
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Lestrade L. Cancer épithélial évolué de l’ovaire de la patiente âgée: quel état des lieux suite à la Conférence internationale de Vancouver? ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-1988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The chronological age of a patient should not be a barrier to apply chemotherapy. Elderly patients can benefit from chemotherapy. Chronological age should not be a reason for diagnostic or therapeutic nihilism, as the age of a patient poorly characterizes their health situation. Data with high level of evidence on treatment of elderly patients with cancer are limited. A comprehensive geriatric assessment (CGA) describes the individual deficits and resources of a patient much better. Limitations in CGA are risk factors for increased toxicity and decreased treatment benefit. The currently available data demonstrate under- and over-treatment in elderly patients with cancer.
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Affiliation(s)
- U Wedding
- Klinik für Innere Medizin II, Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland.
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Sorbye H, Pfeiffer P, Cavalli-Björkman N, Qvortrup C, Holsen MH, Wentzel-Larsen T, Glimelius B. Clinical trial enrollment, patient characteristics, and survival differences in prospectively registered metastatic colorectal cancer patients. Cancer 2009; 115:4679-4687. [DOI: 10.1002/cncr.24527] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Estimating the Applicability of Wound Care Randomized Controlled Trials to General Wound-Care Populations by Estimating the Percentage of Individuals Excluded from a Typical Wound-Care Population in Such Trials. Adv Skin Wound Care 2009; 22:316-24. [DOI: 10.1097/01.asw.0000305486.06358.e0] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d'Investigateurs Nationaux Pour les Etudes des Cancers de l'Ovaire (GINECO). Cancer 2009; 115:1234-44. [PMID: 19189349 DOI: 10.1002/cncr.24149] [Citation(s) in RCA: 1064] [Impact Index Per Article: 70.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Primary surgery followed by platinum-taxane based chemotherapy has been the standard therapy in advanced ovarian cancer. However, the prognostic role of complete and so-called optimal and suboptimal debulking and its interaction with biological factors has not been not fully defined. METHODS Exploratory analysis was conducted of 3 prospective randomized trials (AGO-OVAR 3, 5, and 7) investigating platinum-taxane based chemotherapy regimens in advanced ovarian cancer conducted between 1995 and 2002. RESULTS A total of 3126 patients were analyzed. Approximately one-third each fulfilled criteria for complete resection (group A), small residual tumor burden of 1-10 mm (group B), or macroscopic residual disease exceeding 1 cm in diameter (group C). Multivariate analysis showed improved progression-free and overall survival for group A with complete resection compared with groups B or C (P<.0001). The impact of so-called optimal debulking as in group B showed a smaller prognostic impact compared with group C. Further independent prognostic factors for overall survival were age, performance status, grade, FIGO stage, and histology, namely the mucinous subtype. An interaction between residual tumor and some biologic factors was demonstrated. CONCLUSIONS The goal of primary surgery should be complete resection. The prognostic impact of tumor biology seemed to be partially overruled by residual tumor and further evaluation of biologic factors should stratify for residual tumor.
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Affiliation(s)
- Andreas du Bois
- Department of Gynecology & Gynecologic Oncology, Dr. Horst Schmidt Klinik, HSK Wiesbaden, Germany (AGO-OVAR).
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Robinson WR, Ritter J, Rogers AS, Tedjarati S, Lieberenz C. Clinical Trial Participation Is Associated With Improved Outcome in Women With Ovarian Cancer. Int J Gynecol Cancer 2009; 19:124-8. [DOI: 10.1111/igj.0b013e31819a1ce8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives:To determine the effect of participation in clinical trials on survival of women with ovarian cancer. Disease-specific factors and demographics were also examined.Methods:A total of 158 women were treated for ovarian cancer at a regional cancer center. All patients were offered treatment with surgery/chemotherapy and were screened at diagnosis for participation in clinical research. Progression-free and overall survival, as well as demographic- and treatment-related data, were recorded.Results:Fifty-three participated in clinical trials and 105 did not. On-study versus off-study subjects were similar in age (64.1 vs 63.5 years), ethnicity (87% vs 85% white), performance status (100% 0-1 Gynecologic Oncology Group scale), and urban versus rural lifestyle (58% vs 55% urban). Stage of disease, histologic subtype, and type/amount of therapy were also similar. Kaplan-Meier analysis showed superior overall survival for on-study subjects (median, 46 vs 25 months, 95% confidence interval, 1.0299-2.1505 months, P = 0.0343). A trend toward improved progression-free survival approached significance for on-study subjects (median, 23 vs 9 months, 95% confidence interval, 0.9545-2.0022 months, P = 0.0866).Conclusions:Women with ovarian cancer who participate in clinical trials at this institution have improved survival compared with those who are treated with standard therapies. No other factors examined were associated with treatment completion or survival. Further, participation in clinical research does not vary by age, ethnicity, urban versus rural lifestyle, or cancer stage or histologic subtype. However, disclosure of this information to potential clinical trial participants may represent an ethical conflict and should be carefully considered in light of existing ethical guidelines for human subject research.
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Willingness of gynecologic cancer patients to participate in clinical trials. Gynecol Oncol 2009; 112:161-5. [DOI: 10.1016/j.ygyno.2008.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 08/25/2008] [Accepted: 09/02/2008] [Indexed: 11/24/2022]
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Biasoli I, Franchi-Rezgui P, Sibon D, Brière J, de Kerviler E, Thieblemont C, Levy V, Gisselbrecht C, Brice P. Analysis of factors influencing inclusion of 102 patients with stage III/IV Hodgkin's lymphoma in a randomized trial for first-line chemotherapy. Ann Oncol 2008; 19:1915-20. [DOI: 10.1093/annonc/mdn391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Janda M, Youlden DR, Baade PD, Jackson D, Obermair A. Elderly patients with stage III or IV ovarian cancer: should they receive standard care? Int J Gynecol Cancer 2008; 18:896-907. [DOI: 10.1111/j.1525-1438.2007.01122.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Due to the higher risk of morbidity and perioperative mortality compared to younger patients, elderly patients with advanced ovarian cancer are challenging to treat. A population-based analysis was performed to predict treatment outcomes and establish risk factors for early death of elderly patients with advanced ovarian cancer using a cohort of 3994 women diagnosed with stage III or IV ovarian cancer between 1992 and 1999, registered with the Surveillance, Epidemiology and End Results Cancer Registries. A multivariate accelerated failure time model allowed estimation of a risk factor model for overall survival. Patient's age, stage at presentation, presence of comorbidities, and oncology treatment facility were independently associated with overall survival at 12 months from diagnosis. Patients were assigned to low (0–7 points), moderate (8–14 points) or high (≥15 points) risk groups according to accumulation of risk factors, which showed good ability to predict 12-month mortality (receiver–operator characteristics curve [ROC] derivation cohort = 0.763; ROC validation cohort = 0.756). Across all three risk groups, patients who received both surgery and chemotherapy showed significantly improved survival as compared to patients who received only surgery or chemotherapy. For patients 80 years and over who had upfront surgery, perioperative mortality was significantly greater in the high-risk group (21%; 95% CI = 16–26%) compared to patients within the moderate (8%; 95% CI = 5–12%) and low-risk groups (0%; 95% CI = 0–11%). The risk factor profile established could be helpful to plan future clinical trials to establish optimal treatment for elderly patients with advanced stage ovarian cancer
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Wedding U, Höffken K, Friedrich C, Pientka L. [Health services research and geriatrics: deficits and research approaches using the example of colorectal carcinoma and anaemia]. ACTA ACUST UNITED AC 2008; 101:587-92. [PMID: 18269048 DOI: 10.1016/j.zgesun.2007.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The number of elderly people with cancer will increase within the next decades. Cancer will surpass cardiovascular diseases as the leading cause of death. In comparison to younger patients elderly patients with cancer are less often treated within the scope of clinical trials. Data from health care research demonstrate that the treatment of elderly patients is less often guideline-directed than that of younger patients. This will be demonstrated in more detail for patients with colorectal carcinoma and for patients with anaemia. Older people are reluctant to participate in programs for the early detection of colorectal carcinoma and its precursors. They less often receive adjuvant chemotherapy in stage III disease, despite the fact that adjuvant chemotherapy is no more toxic than in younger patients and equally effective and therefore recommended in the guidelines. Compared to younger patients, elderly patients less often receive palliative chemotherapy in stage IV disease. Anaemia has a prevalence of about 10% in people aged 65 and more; the reported values are highly variable. There is a lack of data on the grade of evaluation. Also, there are no diagnostic and therapeutic guidelines in Germany. Health services research will play an important role in assessing deficits in the diagnosis and therapy of cancer diseases in the elderly and in determining the goals for future efforts in health care and research.
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Affiliation(s)
- Ulrich Wedding
- Klinik und Poliklinik für Innere Medizin II, Abteilung Hämatologie und Onkologie, Friedrich-Schiller-Universität, Jena.
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Hilpert F, du Bois A, Greimel ER, Hedderich J, Krause G, Venhoff L, Loibl S, Pfisterer J. 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 2006; 18:282-7. [PMID: 17082513 DOI: 10.1093/annonc/mdl401] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate first-line platinum/paclitaxel (Taxol) under phase III trial conditions in ovarian cancer (OC) patients aged >or=70 years. PATIENTS AND METHODS Phase III results of 779 patients with OC International Federation of Gynecology and Obstetrics (FIGO) stage IIB/IV treated with cisplatin/paclitaxel versus carboplatin/paclitaxel were retrospectively analyzed according to feasibility, toxicity (National Cancer Institute Common Toxicity Criteria) and quality of life (QoL) [European Organization for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30)] in patients aged <70 or >or=70 years. RESULTS One hundred and three (13%) patients were aged >or=70 years. Patient characteristics (<70 versus >or=70 years) showed significant differences with regard to Eastern Cooperative Oncology Group performance status, residual disease and constitutional factors but not to FIGO stage, histology or grading. Elderly patients received 98%, 100% and 96% of the recommended paclitaxel, carboplatin and cisplatin dose, respectively, per cycle. Early discontinuation was more frequent in elderly, although QoL, nonhematological and hematological toxicity were comparable between elderly and younger patients, except for febrile neutropenia (5% versus <1%, P = 0.005). There were no significant differences with regard to cycle delays, dose reductions or the use of granulocyte colony-stimulating factor and antibiotics. CONCLUSION Platinum/paclitaxel appeared to be feasible and tolerable in elderly patients under clinical trial conditions, but there seems to be a different investigators' estimation of toxicity and less intention to maintain trial treatment in elderly.
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Affiliation(s)
- F Hilpert
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Germany.
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Legge F, Eaton D, Molife R, Ferrandina G, Judson I, de Bono J, Kaye S. Participation of patients with gynecological cancer in phase I clinical trials: two years experience in a major cancer center. Gynecol Oncol 2006; 104:551-6. [PMID: 17064758 DOI: 10.1016/j.ygyno.2006.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 09/11/2006] [Accepted: 09/12/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aims at analyzing the clinico-demographic features that influence the recruitment of gynecological cancer (GC) patients to phase I trials. The possible clinical benefit to patients resulting from the participation in these trials has been also investigated. METHODS We performed a retrospective analysis of GC patients referred to the Phase I Unit of the Royal Marsden Hospital in Sutton (Surrey, UK), over 2 years. RESULTS Overall 68 GC patients were referred, and subsequently 32 (47.1%) enrolled. The percentage of patients enrolled increased as the distance to travel between the patient's residence and the hospital shortened (8.3% through 47.8% to 60.8%, for travel time >2, 1-2 or < or =1 h, respectively; p=0.008). Better performance status (PS) was found to be associated with higher enrollment rate with percentages increasing from 0 through 51.2 to 58.8 in cases with PS> or =2, PS=1, PS=0, respectively (p=0.015). Among the biochemical parameters, only hepatobiliary dysfunction was found to be associated with lower enrollment (p=0.012). Minimal response/disease stabilization was observed in 11 patients (34.4%). An increased median survival following the first visit was observed in patients enrolled compared to those not enrolled (8 versus 4 months, respectively, p=0.0055). In the multivariate analysis, only PS and enrollment in trials retained an independent prognostic role (p=0.031 and p=0.040, respectively). CONCLUSIONS This study, suggesting liver function and PS as important factors influencing the recruitment of GC patients to phase I trials could guide referral of patients to phase I Units. Moreover, the practical limitations imposed by long distance travel, together with the potential clinical benefit due to the participation to these trials, should encourage more investigators to develop phase I units in major cancer centers.
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Affiliation(s)
- F Legge
- Gynecologic Oncology Unit, Catholic University of Campobasso, Italy; Gynecologic Oncology Unit, Catholic University of Rome, Italy.
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