Ovarian cancer in the older patient: where are we now? What to do next?

Abstract

In recent years, major advances have been made toward the individualization of epithelial ovarian cancer care, leading to an overall improvement of patient outcomes. However, real-life data indicate that the oldest populations do not benefit from this, due to aspects related to cancer (more aggressive histopathological features), treatment (i.e. frequently suboptimal), and the host (increased toxicities in patients with lower physiological reserve). A specific risk–benefit perspective should therefore be taken when considering surgery, chemotherapy, and maintenance treatments: the decision for cytoreductive surgery should include geriatric vulnerability and surgical complexity, neo-adjuvant chemotherapy being an option when primary surgery appears at high risk; carboplatin paclitaxel association remains the standard even in vulnerable older patients; and bevacizumab and poly(ADP-ribose) polymerase inhibitors maintenance are interesting options provided they are prescribed according to their indications with a close monitoring of their toxicities. Future studies should aim to individualize care without limiting access of older patients to innovation. A specific focus is needed on age-specific translational analyses (focusing on tumor mutational burden and impaired biological pathways), a better patient stratification according to geriatric parameters, an adaptation of both oncological treatment and geriatric interventions, and treatment adaptations not a priori but according to formal pharmacokinetic data.

Ovarian Cancer in the Older Manitoban Population—Treatment Tolerance and Cancer-Related Outcomes: A Manitoba Ovarian Cancer Outcomes (MOCO) Group Study

“…Geriatric patients are often excluded from randomized clinical trials, and therefore the best course of treatment for this patent population is poorly understood [ 5 , 6 ]. Individuals over the age of 70 comprise a large proportion of epithelial ovarian cancer patients and often have co-morbidities, polypharmacy, or decreased functional status [ 7 , 8 ]. Consequently, the evidence base for the treatment of epithelial ovarian cancer is drawn primarily from experiences with younger, healthier patients.…”

The role of circRNAs in regulation of drug resistance in ovarian cancer

“…The most common ovarian cancer is epithelial ovarian cancer, and the other types include stromal tumors and germ cell tumors ( Arnaoutoglou et al, 2023 ). It is unknown regarding the cause of ovarian cancer development; however, several risk factors could contribute to ovarian carcinogenesis, such as a family history of ovarian cancer, age and certain reproductive factors ( Ali et al, 2023 ; Rousseau et al, 2023 ). The reproductive factors include early onset of menstruation, late menopause and never having been pregnant.…”