Effect of age on completion of intraperitoneal chemotherapy in ovarian cancer

Background

Intraperitoneal chemotherapy (IP) shows benefits in terms of progression-free survival (PFS) and overall survival (OS) compared with intravenous chemotherapy (IV) for optimally debulked ovarian cancer. However, it is associated with higher toxicity and early discontinuation. Our objective was to evaluate the influence of age on IP chemotherapy completion rate.

Methods

We conducted a retrospective analysis of patients with ovarian epithelial cancer who received adjuvant IV/IP or IP chemotherapy at a single institution from May 2006 to December 2015. Association of age subgroups with baseline clinical characteristics was assessed using Fisher's exact tests. Survival rates for progression-free survival (PFS) analysis were based on Kaplan-Meier estimation and compared using log-rank testing.

Results

A total of 71 patients (pts) with IP catheter port placement were identified. Of them, 48 pts received at least 1 cycle of IP chemotherapy. Median age was 57 years [range 32-74], 41 pts had serous histology (85%), 12 pts (25%) had stage I-II and 36 pts (75%) stage III-IV disease. Among them, 38 pts (79%) had ≤65 years and 10 pts (21%) were >65 years. Median follow-up was 53.3 months [range 35.2–71.3]. Complete resection (89% vs 60%, p = 0.047) and completion rate of IP chemotherapy (84% vs 30%, p = 0.002), were found to be significantly different between patients ≤65 compared to >65 years, respectively. Five-year progression-free survival (PFS) was 54.1% versus 34.3%, respectively (HR: 0.79 [95% CI 0.23-2.78], p = 0.719). Neither statistical significantly differences in comorbidities (84% vs 70%) nor grade 3-4 toxicity profile (47% vs 70% p = 0.292) were observed between both groups of patients respectively. Reasons for treatment discontinuation include: renal failure in 4 pts, abdominal pain in 3 pts, withdrawal for 2 pts, syncope, neurologic toxicity, and intestinal occlusion in 1 pt each; and 1 pt due to catheter related complication.

Conclusions

In this cohort, the IP chemotherapy completion rate in elderly patients was lower than in younger counterparts. However, grade 3-4 toxicity rates and survival outcomes differences were not observed.

Clinical trial identification

Legal entity responsible for the study

Hospital Aleman

Funding

Medical Oncology Section, Hospital Aleman

Disclosure

All authors have declared no conflicts of interest.