According to a recent article published in the journal
Cancer, performance status, not age, should determine a patient’s suitability for chemotherapy in recurrent ovarian cancer.
Ovarian cancer is a common malignancy, with about 25,000 new cases diagnosed each year in the United States. The ovary makes female hormones and stores all of the eggs that are released once a month during ovulation. There are two ovaries, one on each side of the uterus. The earlier ovarian cancer is detected, the higher the cure rate. Unfortunately, because ovarian cancer begins deep in the pelvis and often does not cause any symptoms until advanced stages, the disease often goes unnoticed until it has reached a stage where it is incurable. Most women with ovarian cancer have advanced disease at the time of diagnosis. This means the cancer has spread from the ovary to other body locations within the abdomen, such as the surface or inside of the liver, intestine, or lymph nodes. Although many patients have an anti-cancer response to initial therapy, the majority of patients with advanced ovarian cancer ultimately experience a cancer recurrence.
Although the incidence of ovarian cancer is common in patients over 65, some physicians are reluctant to treat elderly patients in the same manner as their younger counterparts due to perceived intolerability of therapy. However, more clinical trials and retrospective analyses of data involving elderly patients are beginning to address the issue of survival benefits and tolerability of optimal treatment regimens in elderly patients who have cancer.
Researchers from Denmark recently evaluated data obtained from 102 patients who were treated for recurrent ovarian cancer. Treatment for recurrent disease consisted of the chemotherapy agents Hycamptin® (topotecan) and Paraplatin® (carboplatin). Patients were divided into two groups for evaluation according to age: younger than 65 or older than 65. The elderly group had a less favorable performance status (a measure of how well a patient is able to perform ordinary tasks) than the younger group, but were otherwise similar with regard to other considered variables. The overall anti-cancer response rate following therapy for recurrent cancer was 50% for the younger group and 44% for the elderly group. The overall survival from the first day of treatment for recurrent disease was approximately 13.3 months for younger patients, compared to approximately 11.8 months for elderly patients. With all variables taken into consideration, these researchers concluded that performance status, not age, was the key factor in determining whether a patient was suitable for chemotherapy for recurrent ovarian cancer.
These results indicate that patients over 65 years with a favorable performance status may benefit from chemotherapy for treatment of recurrent ovarian cancer. Patients with recurrent ovarian cancer who are 65 years or older may wish to speak with their physician about the risks and benefits of treatment for their disease or the participation in a clinical trial evaluating novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (
Reference: Gronlund B, Høgdall C, Hansen H, et al. Performance status rather than age is the key prognostic factor in second-line treatment of elderly patients with epithelial ovarian carcinoma. Cancer. 2002;94:1961-1967.