Chemotherapy in Elderly Patients with Gynecological Cancer

Abstract

Objective: The aim of this study was to determine the tolerability, safety and feasibility of chemotherapy in very elderly patients with gynecological cancers. Methods: We included all patients ≥75 years of age affected by endometrial, ovarian or cervical cancer treated with neoadjuvant, adjuvant or palliative chemotherapy. Data regarding age, stage of the disease, comorbidities, performance status (PS), chemotherapy regimen and dosing, toxicity, treatment delay and dose adjustments were recorded. Results: Forty-nine patients were included in the study. Their median age was 77.5 years. The vast majority of patients (89.8%) presented with advanced neoplastic disease. Twenty-nine of the 49 patients were treated with full-dose chemotherapy; 41% were subjected to the weekly dose. One toxic death was recorded; grade 2 anemia was reported in 8 patients, and grade 2 and 3 neutropenia was recorded in 2 and 3 patients, respectively. Sixty-one percent of the patients completed the planned treatment. Conclusion: Chemotherapy in very elderly patients is feasible with an acceptable toxicity profile. Careful evaluation of PS and assessment of physical and psychological health are necessary to predict tolerability of chemotherapy. A weekly schedule is better tolerated in this setting.

Delay in chemotherapy administration impacts survival in elderly patients with epithelial ovarian cancer

“…This demonstrates that standard doublet therapy is feasible and tolerable in the majority of elderly patients. This corroborates previously published series, which showed 65-77% completion rate for patients over age 65 [20,33].…”

Tolerance of weekly metronomic paclitaxel and carboplatin as neoadjuvant chemotherapy in advanced ovarian cancer patients who are unlikely to tolerate 3 weekly paclitaxel and carboplatin

“…[8] Palaia et al in his audit of elderly patients also concluded that elderly patients receiving weekly therapy tolerated it better. [15] Similarly, in MITO-7 study, weekly paclitaxel and carboplatin adjuvant schedule was better tolerated, with a lower level of hematological toxicity, particularly febrile neutropenia, than the 3 weekly schedule. [16] The regimen had a response rate of 100%, with 27.27% of patients having a complete response.…”

Adjuvant Treatment and Clinical Trials in Elderly Patients With Endometrial Cancer

“…Some studies have shown that chemotherapy and radiotherapy can be well tolerated in this population. 18,19 However, patient motivators and quality of life must be evaluated alongside safety and efficacy when considering adjuvant therapy recommendations in the elderly population. In addition, providers should further investigate barriers that prevent elderly women from receiving guideline directed care.…”

“…They concluded that further evaluation of the physical and psychological role of chemotherapy on quality of life would be warranted. 18 Similarly, multiple providers have found radiation to be safe in elderly patients with EC. 13,19Y21 Fiorentino et al 19 found that adjuvant external beam radiation followed by brachytherapy in elderly patients with EC not only had an acceptable safety profile but also was well tolerated regardless of pre-existing medical comorbidities.…”