Neoadjuvant chemotherapy in high-risk ovarian cancer patients: Role of age.

OBJECTIVE: To review a single-center clinical experience with neoadjuvant chemotherapy (NACT) in a population of frail epithelial ovarian cancer (EOC) patients and investigate the prognostic role of advanced age.

METHODS: We retrospectively reviewed clinical data from 102 advanced EOC patients treated with NACT and presenting high perioperative risk. Patients were divided into 2 groups: group A, including patients aged 70 years or older; and group B, including patients below 70 years old. Univariate and multivariate analyses were performed to compare survival and prognostic factors for survival between the two groups.

RESULTS: Forty-two patients (41.2%) were older than 70 years. Elderly patients were more likely to present comorbidities ( p = .0001), poor performance status ( p = .04), and multiple indications for NACT ( p = .03). They showed a reduced response to NACT, since only 64% of elderly patients underwent surgical debulking (98.3% vs 64.3%, p = .001) and, among these, half of them were optimally debulked (79.3% vs 50%, p = .01). Median progression-free survival (PFS) and overall survival (OS) were significantly lower in group A (respectively, 9 vs 13 months, p = .005, and 21 vs 29 months, p = .01). Advanced age, IV stage, presence of ascites, and residual disease >1 cm were significantly associated with a lower PFS. However, when analyzing factors associated with OS, the only significant ones were higher American Society of Anesthesiologists score and residual disease >1 cm.

CONCLUSIONS: Age was not found to be a prognostic factor for survival. This highlights the necessity of validated geriatric assessment tools predicting functional age and treatment tolerability to avoid undertreatment of elderly patients.