title: Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer - An NRG oncology/Gynecologic Oncology Group study.
abstract: A simple measure to predict chemotherapy tolerance in elderly patients would be useful. We prospectively tested the association of baseline Instrumental Activities of Daily Living (IADL) score with ability to complete 4 cycles of first line chemotherapy without dose reductions or >7days delay in elderly ovarian cancer patients.
  
  
  
  Patients' age ≥70 along with their physicians chose between two regimens: CP (Carboplatin AUC 5, Paclitaxel 135mg/m2) or C (Carboplatin AUC 5), both given every 3weeks either after primary surgery or as neoadjuvant chemotherapy (NACT) with IADL and quality of life assessments performed at baseline, pre-cycle 3, and post-cycle 4.
  
  
  
  Two-hundred-twelve women were enrolled, 152 selecting CP and 60 selecting C. Those who selected CP had higher baseline IADL scores (p<0.001). After adjusting for age and PS, baseline IADL was independently associated with the choice of regimen (p=0.035). The baseline IADL score was not found to be associated with completion of 4 cycles of chemotherapy without dose reduction or delays (p=0.21), but was associated with completion of 4 cycles of chemotherapy regardless of dose reduction and delay (p=0.008) and toxicity, with the odds ratio (OR) of grade 3+ toxicity decreasing 17% (OR: 0.83; 95%CI: 0.72-0.96; p=0.013) for each additional activity in which the patient was independent. After adjustment for chemotherapy regimen, IADL was also associated with overall survival (p=0.019) for patients receiving CP.
  
  
  
  Patients with a higher baseline IADL score (more independent) were more likely to complete 4 cycles of chemotherapy and less likely to experience grade 3 or higher toxicity.
authors.affiliation: Division of Gynecologic Oncology, Summa Akron City Hospital, NEOMED, Akron, OH 44304, United States. Electronic address: vongruev@summahealth.org.
authors.forename: Vivian E
authors.initials: VE
authors.lastname: von Gruenigen
authors.affiliation: NRG Oncology Statistics & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States. Electronic address: hquang@gogstats.org.
authors.forename: Helen Q
authors.initials: HQ
authors.lastname: Huang
authors.affiliation: Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA 15213, United States; Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, United States; Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States. Electronic address: beumerjh@upmc.edu.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Beumer
authors.affiliation: NRG Oncology Statistics & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States. Electronic address: hlankes@gogstats.org.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Lankes
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Medicine, Gynecologic Medical Oncology Service, New York, NY 10065, United States. Electronic address: teww@MSKCC.org.
authors.forename: William
authors.initials: W
authors.lastname: Tew
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Cancer Center, New York NY, 10032, United States. Electronic address: herzogt@ucmail.uc.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Herzog
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Cancer Center, New York NY, 10032, United States. Electronic address: ahurria@coh.org.
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.affiliation: Division of Obstetrics & Gynecology, The Peggy and Charles Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States. Electronic address: Robert-Mannel@ouhsc.edu.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Mannel
authors.affiliation: Dept. of Gynecologic Oncology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States. Electronic address: trizack@wihri.org.
authors.forename: Tina
authors.initials: T
authors.lastname: Rizack
authors.affiliation: Division of Obstetrics & Gynecology, The Peggy and Charles Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States. Electronic address: lisa-landrum@ouhsc.edu.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Landrum
authors.affiliation: Dept. of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44109, United States.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.affiliation: Dept. of Gynecologic Oncology, Ohio State University Medical Center, Columbus, OH 43210, United States. Electronic address: Ritu.Salani@osumc.edu.
authors.forename: Ritu
authors.initials: R
authors.lastname: Salani
authors.affiliation: Dept. of OB/GYN, Medical College of Wisconsin, Milwaukee, WI 53226, United States. Electronic address: wbrabley@mcw.edu.
authors.forename: William H
authors.initials: WH
authors.lastname: Bradley
authors.affiliation: Dept. of OB/GYN, Western Connecticut Health Network, Norwalk, CT 06856, United States. Electronic address: thomas.rutherford@yale.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Rutherford
authors.affiliation: Dept. of Gynecologic Oncology, Carolinas Medical Center, Blumenthal Cancer Center, Charlotte, NC 28203, United States. Electronic address: robert.higgins@carolinashealthcare.org.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Higgins
authors.affiliation: Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC 27710, United States; Dept. of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, United States. Electronic address: angeles.secord@duke.edu.
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.affiliation: Section of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, IL 60637, United States. Electronic address: gfleming@medicine.bsd.uchicago.edu.
authors.forename: Gini
authors.initials: G
authors.lastname: Fleming
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005185:Fallopian Tube Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000473:pathology
keywords: Chemotherapy; Elderly women; Ovarian cancer