Geburtshilfe Frauenheilkd 2014; 74 - FV_05_03
DOI: 10.1055/s-0034-1388574

Early discontinuation of chemotherapy among elderly patients with ovarian cancer under clinical trial conditions – an analysis of the AGO study group

S Saß 1, J Hedderich 2, AM Hempel 3, P Harter 4, S Mahner 5, J Pfisterer 6, A du Bois 4, F Hilpert 3
  • 1Friedrich-Ebert-Krankenhaus, Medizinische Klinik, Neumünster, Germany
  • 2UKSH, Institut für Medizinische Informatik und Statistik, Kiel, Germany
  • 3UKSH, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
  • 4Kliniken-Essen-Mitte GmbH Huyssens-Stiftung/Knappschaft, Frauenklinik, Essen, Germany
  • 5Universitätsklinikum Hamburg-Eppendorf, Univ.-Frauenklinik und Poliklinik, Hamburg, Germany
  • 6Zentrum f. Gynäkologische Onkologie, Kiel, Germany

Age is a negative prognostic factor for survival in ovarian cancer (OC) even under controlled clinical trial conditions. The number of chemotherapy (CTX) cycles is an independent prognostic factor for survival in elderly patients (EP) in previous results. Now we analysed the reasons for early discontinuation (ED) in EP receiving platinum/taxane-based CTX in advanced OC.

Datasets from 3 randomized phase-III trials (AGO-OVAR 3, 5, 7) investigating platinum/taxane-based chemotherapy in OC FIGO IIB-IV were merged into a combined meta-dataset. 359 (10.8%) EP ≥70 years of age out of 3333 patients who had received at least one cycle of the assigned treatment were analysed with regard to reasons for ED (≤4 cycles).

ED occurred in 65 EP (18.1% vs. 9.1% in younger, p < 0.001) and the main reasons were toxicity (49.2%), patient's refusal (27.7%) and progression or death (24.6%). ED occurred in 22 (33.8%) patients after cycle 1 and 26.2%, 13.8% and 26.1% in subsequent cycles 2 – 4, respectively. While toxicity or patients refusal-related ED occurred continuously during the first four cycles, there was a peak of progression or death-related ED in cycle 1 and 2 among EP (11 of 16, 68.8%). There were no significant differences with regard to dose reductions, cycle delays and supportive therapy between EP and their younger counterparts.

There seems to be some scope to maintain treatment in case of toxicity- or patients attitude-related problems but there is a notable number of EP who discontinues study treatment due to early progression or death.