Age contrasts in patients with advanced epithelial ovarian cancer: The M. D. Anderson cancer center experience

Background. This study reviews the experience at the University of Texas M. D. Anderson Cancer Center with elderly patients treated for advanced epithelial ovarian cancer with cisplatin‐based combination chemotherapy. Methods. From 1978 through 1988, 215 patients with Stage III or IV, Grade 2 or 3 epithelial ovarian cancer were entered onto one of three consecutive trials involving cisplatin‐based combination chemotherapy. The treatment plans were as follows: Trial 1:12 cycles of cisplatin–melphalan (75 patients); Trial 2: 12 cycles of cisplatin–cyclophosphamide (49 patients); and Trial 3: 6 cycles of cisplatin–cyclophosphamide (91 patients). End‐points of analysis included the effect of age on other prognostic factors, clinical response rate, surgical response rate, toxicity, progression‐free survival, and survival. Results. Of the entire study group, 57 patients (27%) were 65 years of age and older at diagnosis. There was no effect of age on FIGO stage or histologic grade distribution, but 61% of patients younger than 65 years of age had residual tumors less than or equal to 2 cm compared with only 33% of patients 65 years of age and older (P = 0.00027). There were no differences between the two age groups with respect to response rates, recurrence rate after negative second‐look surgery, toxicity, or progression‐free survival. Patients in the younger than 65 years of age group, however, had a significantly longer median survival time than those 65 years of age and older (30 versus 19 months, respectively) (P = 0.0038). Conclusions. This analysis suggests that elderly patients are more likely to begin chemotherapy with bulky residual disease and to have a significantly shorter survival time than their younger counterparts.