Abstract
It is now widely acknowledged that the elderly represent a significant proportion of advanced ovarian cancer patients and that age is negatively linked to the use of chemotherapy (Thigpen T, Brady MF, Omura GA, et al. Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group experience. Cancer. 1993;71:606–14, Uyar D, Frasure HE, Markman M, von Gruenigen VE. Treatment patterns by decade of life in elderly women (> or =70 years of age) with ovarian cancer. Gynecol Oncol. 2005;98:403–8). Despite having been neglected and excluded from clinical trials in the past, these patients may at present benefit from the same advances in cancer care as their younger counterparts do provided geriatric assessment including comorbidities is taken into account (Freyer G, Tew WP, Moore KN. Treatment and trials: ovarian cancer in older women. Am Soc Clin Oncol Educ Book. 2013;227–235, Chia VM, O’malley CD, Danese MD et al. Prevalence and incidence of comorbidities in elderly women with ovarian cancer. Gynecol Oncol. 2013;129:346–52). Indeed, age itself is not a poor prognostic factor, at least for frontline chemotherapy (Eisenhauer EL, Tew WP, Levine DA et al. Response and outcomes in elderly patients with stages IIIC-IV ovarian cancer receiving platinum-taxane chemotherapy. Gynecol Oncol. 2007;106:381–7). Owing to the advances that have been achieved in the care of elderly patients either for surgery or medical therapy, the lower boundary for old age has evolved from 65 years old (that is currently considered as absolutely inappropriate) to 70 and 75 years old. Indeed, an international effort has been undertaken to better handle elderly cancer patients, with the development of oncogeriatrics and the incorporation of geriatric issues in oncology trials. In France, the different iterations of the French plan cancer, besides the nationwide implementation of coordination units in oncogeriatrics supported by the National Institute for Cancer (INCa) as well as the efforts of collaborative groups such as GINECO, have put to the foreground the problematic of ovarian cancer in the elderly. Of note, although most of the effort was put on the care of newly diagnosed patients with trials focusing on frontline chemotherapy, there is a need for exploring the benefits and pitfalls of salvage therapy in relapsing patients as at least second and third lines of chemotherapy may increase survival (Hanker LC, Loibl S, Burchardi N et al. The impact of second to sixth line therapy on survival of relapsed ovarian cancer after primary taxane/platinum-based therapy. Ann Oncol. 2012;23:2605–12). This is indeed a relevant issue, as most of patients with advanced disease at diagnosis will experience a relapse, and as ovarian cancer incidence peaks in the 70s, we need to define strategies of care that fits well to the elderly relapsing patients.
Published Version
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