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Debate 10B - Patients with Advanced Ovarian Cancer who are 75 Years Old and Above Should Routinely be Treated with Neoadjuvant Chemotherapy?

No

from Section III - Ovarian Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

NACT should be used in women unfit for PDS or those with truly unresectable disease, not just older women. We believe the real question of this debate is how do we safely maximize the number of women ≥75 who are treated with PDS with an optimal resection resulting in the longest survival, while identifying vulnerable women in whom the morbidity of PDS is too great and thus NACT is the better approach. Multiple objective and easy to use tools have been developed to assess a patient’s functional status, something that is rarely represented by chronologic age. We must not forget that clinical trials commonly either do not assess functional status or exclude older women, and the number of trials focusing on the older population is low. An all or nothing approach is never the best answer, especially in the older, commonly more vulnerable, population.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Long Roche, K, et al. Practical guidelines for trial to neoadjuvant chemotherapy in advanced ovarian cancer: big risk, big reward … or too much risk? Gynecol Oncol 2020;157:561562.CrossRefGoogle ScholarPubMed
Onda, T, et al. Comparison or survival between primary debulking surgery and neoadjuvant chemotherapy for stage III/IV ovarian, tubal and peritoneal cancers in phase III randomized trial. Eur J Cancer 2020;130:114125.CrossRefGoogle ScholarPubMed
Wright, AA, et al. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. Gynecol Oncol 2016;143:315.CrossRefGoogle ScholarPubMed
Falandry, C, et al. EWOC-1: a randomized trial to evaluate the feasibility of three different first-line chemotherapy regimens for vulnerable elderly with ovarian cancer (OC): a GCIG-ENGOT-GINECO study. J Clin Oncol 2019;37S:ASCO #5508.CrossRefGoogle Scholar
von Gruenigen, VE, et al. Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer – an NRG oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017;144(3):459467.Google Scholar

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