There is a lack of prospective randomised trial data specifically in older populations.
While the majority of trials in the systematic review did not impose an age limit, the median age was most often between 55 and 60 years. Of those trials that did impose an age limit, two trials included patients up to 65 years, one up to 70 years and one up to 80 years.
It is recognised that older women with ovarian cancer have more aggressive tumours, more advanced stage at diagnosis, increased risk of death from their cancer and more comorbidities than younger patients.79 Data from an Australian population-based study also indicate that patients over the age of 70 years are less likely to receive standard chemotherapy.80
The current standard chemotherapy regimen of three weekly carboplatin and paclitaxel is generally well tolerated and has established efficacy in older patients.50 Despite this, alternative strategies such as using single agent carboplatin, reducing the dose and weekly scheduling are used in an attempt to preserve efficacy and reduce toxicity. These therapeutic manoeuvres are based on small phase II trials or retrospective analyses.
In a retrospective analysis of a large prospective trial (GOG182) it was shown that older patients (age > 70 years) were less likely to complete the prescribed 8 cycles of chemotherapy, had a shorter survival and increased toxicity; particularly peripheral neuropathy and bone marrow suppression. These data are published in abstract form only, but this is currently the largest age-specific subgroup analysis of a prospective trial.81 Unfortunately, this subgroup is probably not representative of the wider population of elderly women requiring treatment for ovarian cancer. Prospective trials of chemotherapy in older women are required particularly in patients who are frail or have comorbidities.
The National Comprehensive Cancer Network (NCCN) guidelines for management of cancer in the senior adult contain a specific section on the management of ovarian cancer.82 These guidelines also stress the importance of adequate geriatric assessment that then informs appropriate treatment decisions and guides supportive care for both the patients and their carers. Assessment tools based on factors including functional status, comorbidities, cognitive function and nutritional status can assist a comprehensive geriatric assessment. 82