NACT+interval cytoreduction extends survival in geriatric ovarian cancer

  • Klein DA & al.
  • Am J Obstet Gynecol
  • 14 Aug 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery (CRS) improves OS vs chemotherapy alone in patients aged ≥75 years with ovarian cancer, including those aged >80 years with advanced disease and comorbidities.
  • Use of NACT+interval CRS increased over time.

Why this matters

  • Postoperative morbidity and mortality risks are higher in older patients; individualized treatment may improve outcomes in these patients.

Study design

  • 1661 patients (age, ≥75 years) with ovarian cancer received NACT+interval CRS (n=700) or chemotherapy alone (n=961) during 2004-2014.
  • Funding: Fisher Family Fund; Denise Hale Chair fund; the San Francisco Women’s Leadership Group.

Key results

  • Use of NACT increased from 28% to 50% from 2004-2007 to 2012-2014 (P<.001>
  • Median follow-up was 23 months.
  • 5-year OS was 14%.
  • OS was significantly higher with NACT vs chemotherapy alone (25% vs 7%; HR, 0.44; P<.001>
  • OS benefit with NACT was maintained in patients aged >80 years, with stage III-IV disease and ≥1 comorbidities (HR, 0.28; P<.001>
  • OS was significantly worse in:
    • older patients (age, 80-84 vs 75-79 years; HR, 1.35; P=.002); and
    • advanced vs early-stage disease (HR, 2.06; P=.001).

Limitations

  • Retrospective design.

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