Performance status rather than age is the key prognostic factor in second-line treatment of elderly patients with epithelial ovarian carcinoma

BACKGROUND: Intravenous cytostatic agents as second-line treatment of epithelial ovarian carcinoma have been withheld from many elderly patients because of fear of toxicity. The purpose of the study is to compare the toxicity and efficacy between elderly (older than 65 years of age) and younger (younger than 65 years of age) patients receiving intravenous second-line treatment of epithelial ovarian carcinoma.

METHODS: This study was a retrospective analysis of 286 consecutive patients with primary epithelial ovarian carcinoma. Inclusion criteria included histopathologically documented International Federation of Gynecology and Obstetrics (FIGO) Stage IC-IV epithelial ovarian carcinoma; first-line treatment with paclitaxel and a platinum analog; intravenous second-line treatment with topotecan 1.0 mg/m(2)/day for 5 days, every 3 weeks or paclitaxel (175 mg/m(2)) and carboplatin (AUC 5), every 3 weeks.

RESULTS: One hundred two patients fulfilled the inclusion criteria receiving topotecan (n = 57) or paclitaxel-carboplatin (n = 45) because of refractory or recurrent disease. The patients' age at start of second-line treatment in the younger (n = 68) and the elderly (n = 34) group were median 54.0 years (range, 34.7-64.3) and 69.5 years (range, 65.1-77.2), respectively. In the patient group aged younger than 65 years, initial performance status was more favorable than in patients aged older than 65 years (P = 0.007) whereas the groups were similar in relation to other potential prognostic factors (P > 0.05). For patients aged younger than 65 years, the overall response rate of 50% (95% confidence interval [CI], 37-63%) was similar to the response rate of 44% (95% CI, 27-62%) in patients aged older than 65 years (P = 0.29). The overall survival from the first day of second-line treatment in patients aged younger and older than 65 years were median 13.3+ months (range, 1.2-38.3+) and 11.8+ months (range, 2.0-41.0+), respectively (P = 0.25). In a multivariate Cox analysis, performance status at time of first-line treatment (0 vs.1-2; P = 0.013; hazard ratio [HR], 2.12), performance status at time of second-line treatment (0 vs. 1-2; P = 0.004; HR, 2.47), and response to second-line treatment (CR + PR vs. NC + PD; P < 0.001; HR, 4.38) were found to be independent significant factors for overall survival whereas age (younger than 65 years vs. older than 65 years) yielded no independent information (P = 0.90). No differences in the rate of postponement of treatment, neutropenia Grade 4, thrombocytopenia Grade 3-4, nor hypersensitivity reaction to either cytostatic agent between older and younger patients were noticed (P > 0.05).

CONCLUSIONS: Modality of second-line treatment of epithelial ovarian carcinoma should be determined more by assessment of performance status than age per se. Second-line treatment with topotecan or paclitaxel-carboplatin can be safely administered in the aged.