title: Improved tolerance of primary chemotherapy with reduced-dose carboplatin and paclitaxel in elderly ovarian cancer patients.
abstract: OBJECTIVE
  Elderly cancer patients are less likely to tolerate chemotherapy. We sought to compare the toxicity profiles and outcomes of elderly ovarian cancer patients treated with standard versus reduced-dose i.v. carboplatin/paclitaxel.
  
  
  METHODS
  A retrospective, multi-center analysis of women > or = 70 years with papillary serous ovarian/primary peritoneal cancers diagnosed from 1994-2005 was performed. Reduced-dose (RD) patients received carboplatin AUC 4-5 and paclitaxel 135 mg/m(2); standard-dose (SD) patients received carboplatin AUC 5-6 and paclitaxel 175 mg/m(2). Patient variables collected included age, stage, performance status (PS), cytoreductive status, Charlson comorbidity scores, and growth factor administration.
  
  
  RESULTS
  One-hundred patients met the study criteria. RD patients (n=26) were significantly older than SD patients (n=74; median age 77.0 versus 74.7, respectively, p=0.014). No differences were noted in stage, comorbidity scores, cytoreductive status or growth factor administration between cohorts. Incidence of grade 3-4 neutropenia was higher in the SD group (54.1% versus 19.2%; p=0.002). SD patients were more likely to experience cumulative toxicity (p=0.003) and required delays in therapy (p=0.05). Although PS was poorer in SD patients (p=0.02), on multivariate analysis, only the administration of the SD regimen predicted toxicity (p=0.008). There were no differences in progression-free or overall survival between cohorts (median follow-up: 34 months). On multivariate analysis, age (p=0.004) and PS (p=0.008) had a significant impact on survival.
  
  
  CONCLUSIONS
  This preliminary data suggests that reduced-dose carboplatin/paclitaxel may be better tolerated but equally effective as the standard regimen in elderly ovarian cancer patients. Age, performance status and other geriatric parameters should be considered when dosing chemotherapy in the elderly.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. amanditan@yahoo.com
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
authors.forename: Vivian
authors.initials: V
authors.lastname: von Gruenigen
authors.forename: Heidi
authors.initials: H
authors.lastname: Gibbons
authors.forename: Fadi
authors.initials: F
authors.lastname: Abushahin
authors.forename: David
authors.initials: D
authors.lastname: Starks
authors.forename: Maurie
authors.initials: M
authors.lastname: Markman
authors.forename: Jerome
authors.initials: J
authors.lastname: Belinson
authors.forename: Peter
authors.initials: P
authors.lastname: Rose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D018283:Cystadenocarcinoma, Papillary / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D017239:Paclitaxel