Contribution of age to clinical trial enrollment and tolerance with ovarian cancer

abstract

Highlights

• •Older patients with ovarian cancer are less likely to enroll on clinical trial.
• •Women ≥ 70 tolerated chemotherapy on trial as well as their younger counterparts
• •Age ≥ 70 is an independent predictor of shorter overall survival in ovarian cancer.

Introduction

Increasing age has been correlated with shorter survival in ovarian cancer patients, a finding attributed to diminished tolerance of standard therapy. Elderly patients, however, are less likely to enroll on clinical trials; thus, limited data exists to evaluate their response to front line treatment. This study describes how elderly patients on trial fared, with respect to toxicity and response, compared to younger women.

Methods

A retrospective cohort study was performed of ovarian cancer patients enrolled in front line chemotherapy trials at our institution between 2000 and 2013. Patients were dichotomized by age: <70 and ≥70 years. Clinical, pathologic, and treatment characteristics were recorded and analyzed using SAS version 9.3.

Results

336 patients were enrolled. Of these, 79 (23.5%) were ≥70 yrs. Demographics were similar between the two groups. Compared to patients <70, those ≥70 completed a comparable number of chemotherapy cycles (p = 0.16) and had similar numbers of dose modifications (p = 0.40) and delays (p = 0.26). Both hematologic and non-hematologic toxicities occurred at similar rates as well. Age ≥ 70 (HR 1.8, 95% CI 1.27–2.54, p = 0.0009), stage III/IV (HR 3.44, 95% CI 1.08–10.95, p = 0.036), and residual disease (HR 2.63, 95% CI 1.82–3.78, p < 0.0001) were independently predictive of shorter overall survival.

Conclusion

Our data continues to support reports of shorter survival for older women with ovarian cancer. With physician bias removed and similar chemotherapy tolerance noted, our study suggests that inherent tumor biology may be a significant contributor. Further research is needed to identify the mechanisms which contribute to the inequality that age imposes on outcomes.