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  • A multicenter retrospective study to assess feasibility, safety and efficacy of first-line carboplatin-paclitaxel versus carboplatin monotherapy in a frail, elderly epithelial ovarian cancer population

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Original research
A multicenter retrospective study to assess feasibility, safety and efficacy of first-line carboplatin-paclitaxel versus carboplatin monotherapy in a frail, elderly epithelial ovarian cancer population
  1. Eve Merry1,
  2. Ronas Taner Kesmez2,
  3. Tamara Yu1,
  4. Michael Flynn1,
  5. Jonathan Ledermann1,3,
  6. Michelle Lockley1,2,
  7. Nicola Macdonald4,
  8. Mary McCormack5,
  9. Shibani Nicum1,
  10. Shanthini Crusz6 and
  11. Rowan Miller1,6
    1. 1Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
    2. 2Bart's Cancer Institute, Queen Mary University of London, London, UK
    3. 3UCL Cancer Institute, London, UK
    4. 4Gynaecological Oncology, University College London Hospitals NHS Foundation Trust, London, UK
    5. 5Oncology, University College London Hospitals NHS Foundation Trust, London, UK
    6. 6Medical Oncology, Barts Health NHS Trust, London, UK
    1. Correspondence to Dr Eve Merry, Medical Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK; Eve.Merry{at}nhs.net

    Abstract

    Objective Underrepresentation of elderly ovarian cancer patients in clinical trials has led to lack of clarity regarding optimal first-line chemotherapy in this cohort. The Elderly Women with Ovarian Cancer (EWOC)-1 trial demonstrated that 3-weekly carboplatin (3wC) resulted in worse survival and feasibility compared with standard 3-weekly carboplatin-paclitaxel (3wCP) in frail, elderly ovarian cancer patients. Our retrospective study compares feasibility, safety, and efficacy of first-line 3wCP and 3wC in a frail ovarian cancer cohort.

    Methods Clinical data were retrospectively analyzed for newly-diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV, ≥70-year-old epithelial ovarian cancer patients, treated by clinician choice with 3wC or 3wCP at two London cancer centers over a 2 year period. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status provided surrogate markers of frailty. Common Terminology Criteria for Adverse Events v5.0 graded toxicity.

    Results A total of 107 patients were treated with 3wC (n=30) and 3wCP (n=77). Age, performance status, and CCI were significantly different between cohorts, with 3wC patients older (84 vs 75 years, p<0.001), with more comorbidities (median CCI 4 vs 3, p<0.001) and worse performance status (47% vs 17% PS ≥2, p=0.015). Surgical outcomes differed significantly between cohorts, with 20 (67%) 3wC patients not undergoing surgery, compared with 22 (29%) 3wCP patients (p<0.001). Median follow-up was 45.8 months (IQR 38.7–56.3 months). While we observed improved progression-free (HR 0.55, 95% CI 0.33 to 0.90, p=0.017) and overall survival (HR 0.44, 95% CI 0.27 to 0.73, p=0.001, log-rank test) in a univariate cox proportional hazards comparison between 3wCP and 3wC, this was not significant on multivariate analysis. Completion of six planned chemotherapy cycles was achieved by the majority, with similar discontinuation rates between groups (13% 3wC vs 8% 3wCP, p>0.05). Overall grade ≥3 hematological toxicity rates were similar between regimens (33% 3wC vs 44% 3wCP, p=0.37) with grade ≥3 neutropenia (p=0.019) and grade ≥3 thrombocytopenia (p=0.006) more common with 3wCP and 3wC, respectively. No treatment-related deaths occurred.

    Conclusion Our data demonstrates that standard 3wCP is a well-tolerated, feasible first-line treatment for frail, elderly ovarian cancer patients. Improved survival with 3wCP was not significant when corrected for established clinical prognostic factors.

    • Ovarian Cancer
    • Frail Elderly
    • Carboplatin
    • Paclitaxel
    • Feasibility Studies

    Data availability statement

    Data are available upon reasonable request. Anonymized generated and analyzed data sets are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2024-005394

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      Data availability statement

      Data are available upon reasonable request. Anonymized generated and analyzed data sets are available upon reasonable request.

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      Footnotes

      • EM and RTK are joint first authors.

      • Presented at This original research was presented prior to final data collection, as a short oral presentation at British Gynaecological Cancer Society annual conference 2021 and as an e-poster presentation at ESGO 2022 Congress.

      • Contributors EM and RTK contributed equally to this paper and are recognized as joint first authors. All listed authors meet all four ICMJE criteria for authorship. Conceptualization and design: All authors (EM, RTK, TY, MF, JL, ML, NM, MM, SN, SC, RM). Data collection and analysis: RK, EM, TY, RM. All authors contributed to drafting and critically revising the content of the manuscript. All authors have read and agreed to the published version of the manuscript. RM is the guarantor of this work. The corresponding author (EM) had full access to all of the data and the final responsibility to submit for publication.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.