Skip to main content

Ovarian Cancer: Primary Chemotherapy

  • Chapter
  • First Online:
  • 761 Accesses

Abstract

Since primary (first-line) platinum-based chemotherapy is a potentially curative treatment in conjunction with a debulking surgery for newly diagnosed ovarian cancer, it is important to explore these options with all patients regardless of age. Careful consideration of the dosing and scheduling of chemotherapy is required in our older patients. Although few prospective trials dedicated to older patients with newly diagnosed ovarian cancer have been performed, there have been several papers outlining outcomes and options for older patients. In this chapter, we will review the current guidelines and evidence for various intravenous and intraperitoneal chemotherapy regimens.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Edwards BK, Howe HL, Ries LA, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer. 2002;94:2766–92.

    Article  PubMed  Google Scholar 

  2. Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31:128–36.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  CAS  Google Scholar 

  4. Hightower RD, Nguyen HN, Averette HE, et al. National survey of ovarian carcinoma. IV: patterns of care and related survival for older patients. Cancer. 1994;73:377–83.

    Article  PubMed  CAS  Google Scholar 

  5. Pignata S, Vermorken JB. Ovarian cancer in the elderly. Crit Rev Oncol Hematol. 2004;49:77–86.

    Article  PubMed  Google Scholar 

  6. McGuire WP, Hoskins WJ, Brady MF, et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med. 1996;334:1–6.

    Article  PubMed  CAS  Google Scholar 

  7. Ozols RF, Bundy BN, Greer BE, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2003;21:3194–200.

    Article  PubMed  CAS  Google Scholar 

  8. Maas HA, Kruitwagen RF, Lemmens VE, et al. The influence of age and co-morbidity on treatment and prognosis of ovarian cancer: a population-based study. Gynecol Oncol. 2005;97:104–9.

    Article  PubMed  CAS  Google Scholar 

  9. Hershman D, Jacobson JS, McBride R, et al. Effectiveness of platinum-based chemotherapy among elderly patients with advanced ovarian cancer. Gynecol Oncol. 2004;94:540–9.

    Article  PubMed  CAS  Google Scholar 

  10. Sundararajan V, Hershman D, Grann VR, et al. Variations in the use of chemotherapy for elderly patients with advanced ovarian cancer: a population-based study. J Clin Oncol. 2002;20:173–8.

    Article  PubMed  Google Scholar 

  11. Farfield KM, Murray K, Lucas FL, et al. Completion of adjuvant chemotherapy and use of health services for old women with epithelial ovarian cancer. J Clin Oncol. 2011;29:3926.

    Google Scholar 

  12. Pignata S, Monfardini S. Single agents should be administered in preference to combination chemotherapy for the treatment of patients over 70 years of age with advanced ovarian carcinoma. Eur J Cancer. 2000;36:817–20.

    Article  PubMed  CAS  Google Scholar 

  13. Pignata S, Breda E, Scambia G, et al. A phase II study of weekly carboplatin and paclitaxel as first-line treatment of elderly patients with advanced ovarian cancer a Multicentre Italian Trial in Ovarian cancer (MITO-5) study. Crit Rev Oncol Hematol. 2008;66:229–36.

    Article  PubMed  Google Scholar 

  14. Tredan O, Geay JF, Touzet S, et al. Carboplatin/cyclophosphamide or carboplatin/paclitaxel in elderly patients with advanced ovarian cancer? Analysis of two consecutive trials from the Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens. Ann Oncol. 2007;18:256–62.

    Article  PubMed  CAS  Google Scholar 

  15. Fader AN, Gruenigen VV, Gibbons H, et al. Improved tolerance of primary chemotherapy with reduced-dose carboplatin and paclitaxel in elderly ovarian cancer patients. Gynecol Oncol. 2008;109:33–8.

    Article  PubMed  CAS  Google Scholar 

  16. Group ICON. Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet. 2002;360:505–15.

    Article  Google Scholar 

  17. Villella JA, Chaudhry T, Pearl ML, et al. Comparison of tolerance of combination carboplatin and paclitaxel chemotherapy by age in women with ovarian cancer. Gynecol Oncol. 2002;86:316–22.

    Article  PubMed  CAS  Google Scholar 

  18. Ceccaroni M, D’Agostino G, Ferrandina G, et al. Gynecological malignancies in elderly patients: is age 70 a limit to standard-dose chemotherapy? An Italian retrospective toxicity multicentric study. Gynecol Oncol. 2002;85:445–50.

    Article  PubMed  CAS  Google Scholar 

  19. 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.

    Article  PubMed  CAS  Google Scholar 

  20. Hilpert F, du Bois A, Greimel ER, et al. Feasibility, toxicity and quality of life of first-line chemotherapy with platinum/paclitaxel in elderly patients aged >= 70 years with advanced ovarian cancer – a study for the AGO OVAR Germany. Ann Oncol. 2007;18:282–7.

    Article  PubMed  CAS  Google Scholar 

  21. Tew WP, Java J, Chi D, et al. Treatment outcomes for older women with advanced ovarian cancer: results from a phase III clinical trial (GOG182). J Clin Oncol. 2010;28:15s (suppl; abstr 5030).

    Google Scholar 

  22. Matulonis UA, Krag KJ, Krasner CN, et al. Phase II prospective study of paclitaxel and carboplatin in older patients with newly diagnosed Mullerian tumors. Gynecol Oncol. 2009;112:294–9.

    Article  Google Scholar 

  23. Schwartz PE. What is the role of neoadjuvant chemotherapy in the management of ovarian cancer? Oncology (Williston Park). 2008;22:1118–25.

    Google Scholar 

  24. Schwartz PE. Contemporary considerations for neoadjuvant chemotherapy in primary ovarian cancer. Curr Oncol Rep. 2009;11:457–65.

    Article  PubMed  Google Scholar 

  25. Hou JY, Kelly MG, Yu H, et al. Neoadjuvant chemotherapy lessens surgical morbidity in advanced ovarian cancer and leads to improved survival in stage IV disease. Gynecol Oncol. 2007;105:211–7.

    Article  PubMed  CAS  Google Scholar 

  26. Kang S, Nam BH. Does neoadjuvant chemotherapy increase optimal cytoreduction rate in advanced ovarian cancer? Meta-analysis of 21 studies. Ann Surg Oncol. 2009;16:2315–20.

    Article  PubMed  Google Scholar 

  27. McLean KA, Shah CA, Thompson SA, et al. Ovarian cancer in the elderly: outcomes with neoadjuvant chemotherapy or primary cytoreduction. Gynecol Oncol. 2010;118:43–6.

    Article  PubMed  Google Scholar 

  28. Vergote I, Trope CG, Amant F, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363:943–53.

    Article  PubMed  CAS  Google Scholar 

  29. Glasgow MA, Yu H, Rutherford TJ, et al. Neoadjuvant chemotherapy is an effective way of managing women with advanced stage ovarian cancer (FIGO stage IIIC and IV). J Surg Oncol. 2012. doi:10.1002/jso.23171.

  30. Chi DS, Bristow RE, Armstrong DK, Karlan BY. Is the easier way ever the better way? J Clin Oncol. 2011;29(31):4073–5.

    Article  PubMed  CAS  Google Scholar 

  31. Chi DS, Musa F, Dao F, et al. An analysis of patients with bulky advanced stage ovarian, tubal, and peritoneal carcinoma treated with primary debulking surgery (PDS) during an identical time period as the randomized EORTC-NCIC trial of PDS vs neoadjuvant chemotherapy (NACT). Gynecol Oncol. 2012;124(1):10–4.

    Article  PubMed  Google Scholar 

  32. Aletti GD, Eisenhauer EL, Santillan A, et al. Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment. Gynecol Oncol. 2011;120(1):23–8.

    Article  PubMed  Google Scholar 

  33. Alberts DS, Liu PY, Hannigan EV, et al. Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med. 1996;335:1950–5.

    Article  PubMed  CAS  Google Scholar 

  34. Markman M, Bundy BN, Alberts DS, et al. Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol. 2001;19:1001–7.

    PubMed  CAS  Google Scholar 

  35. Armstrong DK, Bundy B, Wenzel L, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354:34–43.

    Article  PubMed  CAS  Google Scholar 

  36. Wenzel LB, Huang HQ, Armstrong DK, et al. Health-related quality of life during and after intraperitoneal versus intravenous chemotherapy for optimally debulked ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:437–43.

    Article  PubMed  CAS  Google Scholar 

  37. Brenner BM, Meyer TW, Hostetter TH. Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med. 1982;307:652–9.

    Article  PubMed  CAS  Google Scholar 

  38. Launay-Vacher V, Chatelut E, Lichtman SM, et al. Renal insufficiency in elderly cancer patients: International Society of Geriatric Oncology clinical practice recommendations. Ann Oncol. 2007;18:1314–21.

    Article  PubMed  CAS  Google Scholar 

  39. Launay-Vacher V, Oudard S, Janus N, et al. Prevalence of renal insufficiency in cancer patients and implications for anticancer drug management: the renal insufficiency and anticancer medications (IRMA) study. Cancer. 2007;110:1376–84.

    Article  PubMed  CAS  Google Scholar 

  40. Lichtman SM, Wildiers H, Launay-Vacher V, et al. International Society of Geriatric Oncology (SIOG) recommendations for the adjustment of dosing in elderly cancer patients with renal insufficiency. Eur J Cancer. 2007;43:14–34.

    Article  PubMed  Google Scholar 

  41. Lichtman SM, Hollis D, Miller AA, et al. Prospective evaluation of the relationship of patient age and paclitaxel clinical pharmacology: Cancer and Leukemia Group B (CALGB 9762). J Clin Oncol. 2006;24:1846–51.

    Article  PubMed  CAS  Google Scholar 

  42. O’Cearbhaill RO, Li D, Shi W, et al. Intraperitoneal chemotherapy in older women with ­epithelial ovarian cancer. J Geriatr Oncol. 2012;3(3):189–95.

    Article  Google Scholar 

  43. Kothari R, Nagel C, Koopmeiners JS, et al. The effect of age on the tolerability of intraperitoneal chemotherapy, complication rate, and survival in patients with ovarian cancer. Gynecol Oncol. 2010;119:491–5.

    Article  PubMed  Google Scholar 

  44. Lichtman SM, Wildiers H, Chatelut E, et al. International Society of Geriatric Oncology Chemotherapy Taskforce: evaluation of chemotherapy in older patients–an analysis of the medical literature. J Clin Oncol. 2007;25:1832–43.

    Article  PubMed  CAS  Google Scholar 

  45. Moore DH, Kauderer JT, Bell J, et al. An assessment of age and other factors influencing protocol versus alternative treatments for patients with epithelial ovarian cancer referred to member institutions: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;94:368–74.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to William P. Tew M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Tew, W.P. (2013). Ovarian Cancer: Primary Chemotherapy. In: Lichtman, S., Audisio, R. (eds) Management of Gynecological Cancers in Older Women. Springer, London. https://doi.org/10.1007/978-1-4471-4605-6_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4605-6_11

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2215-9

  • Online ISBN: 978-1-4471-4605-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics