title: Poor performance status (PS) is an indication for an aggressive approach to neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer (EOC).
abstract: BACKGROUND
  Some guidelines suggest that poor performance status (PS) is a contraindication to 1st line chemotherapy. Poor PS is a known adverse prognostic factor in advanced epithelial ovarian cancer (EOC). We show in this retrospective analysis that 1st line chemotherapy in this patient group is not only safe but is associated with good outcomes.
  
  
  METHODS
  A retrospective review of 114 patients with stage III/IV EOC, who presented with a PS ≥3 at diagnosis and treated as inpatients with upfront platinum-based chemotherapy between 2000 and 2013, at the Royal Marsden Hospital, was conducted. The association between clinical parameters and the likelihood of completion of chemotherapy and overall survival (OS) was assessed.
  
  
  RESULTS
  66% of patients completed ≥6cycles of platinum-based chemotherapy. Prognostic factors for completion of chemotherapy were improvement of PS during hospital stay (p<0.001) and doublet-chemotherapy with carboplatin/paclitaxel compared to single-agent carboplatin (p=0.004). A negative trend for completion of treatment was seen for patients with low albumin (<25g/l) and low CA125 levels at baseline. The median OS for all patients was 13.1months (95% CI: 10.4-15.8) and 21.2months (95% CI: 16.5-25.8) for those who completed 6cycles of chemotherapy.
  
  
  CONCLUSIONS
  Upfront platinum-based chemotherapy is feasible, beneficial and tolerable for the majority of patients with advanced EOC and poor PS. Guidelines suggesting that best supportive care is the preferred option for poor PS patients with solid tumours should be revised to exclude those with advanced EOC. An aggressive approach utilising neoadjuvant carboplatin plus paclitaxel should be regarded as standard of care.
authors: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
authors: Heike
authors: H
authors: Seifert
authors: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
authors: Alexandros
authors: A
authors: Georgiou
authors: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
authors: Helen
authors: H
authors: Alexander
authors: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
authors: Jennifer
authors: J
authors: McLachlan
authors: Department of Statistics, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom.
authors: Shankar
authors: S
authors: Bodla
authors: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
authors: Stan
authors: S
authors: Kaye
authors: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
authors: Desmond
authors: D
authors: Barton
authors: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
authors: Marielle
authors: M
authors: Nobbenhuis
authors: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
authors: Martin
authors: M
authors: Gore
authors: Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom. Electronic address: susana.banerjee@rmh.nhs.uk.
authors: Susana
authors: S
authors: Banerjee
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D005185:Fallopian Tube Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000188:drug therapy* / Q000473:pathology; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D017239:Paclitaxel
keywords: Advanced epithelial ovarian cancer; First line chemotherapy; Poor performance status; Prognostic markers