AGGRESSIVE TREATMENT FOR OVARIAN CANCER

Gynecol Oncol. 2015 Aug 26. pii: S0090-8258(15)30107-4. doi: 10.1016/j.ygyno.2015.08.015. [Epub ahead of print]

Poor performance status (PS) is an indication for an aggressive approach to neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer (EOC).

Seifert H1, Georgiou A1, Alexander H1, McLachlan J1, Bodla S2, Kaye S1, Barton D1, Nobbenhuis M1, Gore M1, Banerjee S3.

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Abstract

BACKGROUND: 

Some guidelines suggest that poor PS is a contraindication to 1st line chemotherapy. Poor PS is a known adverse prognostic factor in advanced EOC. We show in this retrospective analysis that 1st line chemotherapy in this patient group is not only safe but is associated with good outcomes.

PATIENTS AND METHODS: 

A retrospective review of 114 patients with stage III/IV EOC, who presented with a PS ≥3 at diagnosis and treated as inpatients with upfront platinum-based chemotherapy between 2000 and 2013, at the Royal Marsden Hospital, was conducted. The association between clinical parameters and the likelihood of completion of chemotherapy and overall survival (OS) was assessed.

RESULTS: 

66% of patients completed ≥6cycles of platinum-based chemotherapy. Prognostic factors for completion of chemotherapy were improvement of PS during hospital stay (p<0 -="" .001="" 10.4="" 13.1months="" 15.8="" 16.5="" 21.2months="" 25.8="" 6cycles="" a="" abstracttext="" albumin="" all="" and="" at="" baseline.="" ca125="" carboplatin="" chemotherapy.="" compared="" completed="" completion="" doublet-chemotherapy="" for="" g="" l="" levels="" low="" median="" negative="" of="" os="" p="0.004)." paclitaxel="" patients="" seen="" single-agent="" the="" those="" to="" treatment="" trend="" was="" who="" with="">

CONCLUSION: 

Upfront platinum-based chemotherapy is feasible, beneficial and tolerable for the majority of patients with advanced EOC and poor PS. Guidelines suggesting that best supportive care is the preferred option for poor PS patients with solid tumours should be revised to exclude those with advanced EOC. An aggressive approach utilising neoadjuvant carboplatin plus paclitaxel should be regarded as standard of care