48MO - Treatment and outcome of elderly patients with advanced ovarian cancer in Germany: QS-OVAR of the AGO Study Group

Background

Treatment of elderly ovarian cancer (OC) patients follows a fine line between risk and benefit and is often below recommended standards. The German quality assurance program QS Ovar provides a deep and representative insight into the treatment of elderly OC patients and their outcome during the past decade.

Methods

All German hospitals with OC patients were asked to document patient characteristics, treatment and outcome of all patients with first diagnosis in the third quarter of 2012, 2016 and 2021, respectively. This analysis is focusing on patients with age =/>75 years and OC FIGO III/IV.

Results

A total of 1951 OC patients were analyzed, 539 (28%) =/> 75 years and 1412 (72%) < 75 years. Elderly and younger showed significant differences in ECOG (ECOG =/> 2: 39% vs 17%), surgical outcome (residual tumor (RT) = 0 cm: 32 vs 54%; RT> 1cm: 37% vs. 22%), chemotherapy (CTX) use (platinum/taxane (TC) + maintenance (M) (31 vs 66%), Carboplatin-mono (C) (15 vs 3%) and survival (PFS: 13 vs 22, HR 1.7 and OS: 21 vs 44 months, HR 2.29). Among elderly, 15% received no surgery and 34% no CTX. Optimal treatment in terms of surgery and/or CTX translated into improved survival and was influenced by numerical age, ECOG, comorbidities and FIGO stage. Subgroup analysis showed no benefit for TC +/-M vs C+/-M in elderly with no RT after surgery (PFS 29 vs 32 months, p= 0.77; OS 52 vs 39 months, p= 0.23) but in pts with RT > 0 cm (PFS 16 vs 10 months, p=0.065; OS 28 vs 20 months, p= 0.032). Incomplete cytoreductive surgery without postoperative CTX (n= 102 (19%)) had no beneficial effect on survival. Median PFS and OS for elderly patients who received no or incomplete (TR> 0cm) surgery without CTX was 3.2 and 2.9 months, resp. 3.2 and 3.4 months, but with subsequent CTX 12 and 14 months, resp. 17 and 26 months (p<0.001).

Conclusions

Treatment decisions in elderly are critical. Treatment patterns offer a potential for de-escalation. The triage for or against surgery should be done with respect to subsequent CTX, whose omission seems to be the worst prognostic factor among the therapeutic modalities. Survival of OC patients with tumor but without CTX was 3 months.

Legal entity responsible for the study

AGO Organkommission Ovar and the AGO Study Group.

Funding

AstraZeneca and GSK.

Disclosure

F. Hilpert: Financial Interests, Personal, Advisory Board: MSD, Immunogen; Financial Interests, Personal, Invited Speaker: MSD, GSK, AstraZeneca, Novartis. J. Pfisterer: Financial Interests, Personal, Advisory Board: Roche, Amgen, AstraZeneca, GSK; Financial Interests, Institutional, Invited Speaker: Roche, GSK. A. Du Bois: Financial Interests, Personal, Advisory Board: AstraZeneca, GSK / Tesaro; Financial Interests, Personal, Invited Speaker: Zodiac. S. Mahner: Financial Interests, Personal, Advisory Board, Honoraria & reimbursement: AbbVie, AstraZeneca, Clovis, Eisai, Novartis, Olympus, Seagen; Financial Interests, Personal, Invited Speaker, Honoraria & reimbursement: GSK, MSD, Pfizer, Roche, Tesaro, Hubro, Nykode; Financial Interests, Institutional, Research Grant: AstraZeneca, Eisai, GSK, MSD, Roche, Tesaro. F. Marmé: Financial Interests, Personal, Invited Speaker: AstraZeneca, GSK/Tesaro, Clovis, Pfizer, Lilly; Financial Interests, Personal, Advisory Board: AstraZeneca, MSD, Novartis, Roche, Gilead/immunomedics, Eisai, PharmaMar, GenomicHealth, Myriad, Seagen; Financial Interests, Institutional, Invited Speaker: Seagen, Daiichi Sankyo, GSK, AstraZeneca, Stemline Menarini, Roche, AstraZeneca, Novartis, Roche, Eisai, Gilead/Immunomedics, MSD, German Breast Group, AGO Research GmbH, Vaccibody, GSK; Financial Interests, Institutional, Advisory Board: Roche, Immunicom; Financial Interests, Institutional, Funding: AstraZeneca, Lilly, Seagen. M. Kerkmann: Financial Interests, Personal, Full or part-time Employment: MMF GmbH; Financial Interests, Institutional, Research Grant: AstraZeneca, Roche, Amgen, Bristol Myers Squibb, Janssen-Cilag, Pharmacosmos, MSD, Takeda; Non-Financial Interests, Personal, Member: Working Group Medical Oncology (AIO) of the German Cancer Society (DKG), Working Group Supportive Care (AGSMO) of the German Cancer Society (DKG), German Cancer Society (DKG). J. Sehouli: Financial Interests, Personal, Advisory Board: Roche, GSK, AstraZeneca, MSD, Tesaro, ImmunoGen, Tubulis, Novocure, Incyte; Financial Interests, Personal, Invited Speaker: Eisai; Financial Interests, Institutional, Funding: Roche, GSK, AstraZeneca; Financial Interests, Institutional, Invited Speaker: Novocure; Non-Financial Interests, Institutional, Proprietary Information: ENGOT/NOGGO; Non-Financial Interests, Personal, Leadership Role, Council Member: ESGO; Non-Financial Interests, Personal, Leadership Role: North-Eastern German Society of Gynecological Oncology (NOGGO), Arbeitsgemeinschaft für Gynäkologische Onkologie (AGO), Pab-Arabian Research Society of Gynecological Oncology (PARSGO). N. De Gregorio: Financial Interests, Personal, Advisory Board: AstraZeneca, Roche, Myriad, Novartis, MSD, GSK, Clovis, Gilead; Other, Personal, Other, Travel expenses: AstraZeneca, Gilead. L.C. Hanker: Financial Interests, Personal, Advisory Board: Amgen, Roche, GSK, MSD, AstraZeneca, Eisai, Novartis, Immunogen. F. Heitz: Financial Interests, Personal, Advisory Board: Roche, AstraZeneca, GSK, NovoCure; Financial Interests, Personal, Invited Speaker: AstraZeneca, GSK. L. Woelber: Financial Interests, Personal, Advisory Board: GSK, Roche, MSD, Eisai, Seagen, AstraZeneca; Financial Interests, Personal, Invited Speaker: Pfizer, Roche, MSD, Seagen, AstraZeneca, Novartis; Financial Interests, Personal, Other, scientific board: med update GmbH; Financial Interests, Personal, Other, speaker: med public GmbH; Financial Interests, Institutional, Invited Speaker: Seagen, MSD, Medac oncology, Vaccibody AS, Roche; Non-Financial Interests, Institutional, Product Samples: Roche diagnostics; Non-Financial Interests, Personal, Leadership Role, current president: ECSVD; Non-Financial Interests, Personal, Leadership Role: AGO study group, AGO commission vulva vagina. L. Holtmann: Financial Interests, Personal, Full or part-time Employment: MMf GmbH; Financial Interests, Institutional, Research Grant: Amgen, AstraZeneca, Bristol Myers-Squibb, Janssen-Cilag, MSD, Pharmacosmos, Roche, Takeda. G. Elser: Other, Personal, Other, Employee: AGO Research GmbH. P. Harter: Financial Interests, Personal, Advisory Board, Value includes honoraria for lectures: AstraZeneca; Financial Interests, Personal, Advisory Board, includes honoraria for lectures: GSK, Roche, MSD; Financial Interests, Personal, Invited Speaker: Amgen, Stryker, Zailab, Eisai, Daiichi Sankyo; Financial Interests, Personal, Advisory Board: Clovis, Immunogen, Novartis, Mersana, Miltenyi; Financial Interests, Personal, Other, IDMC member: Sotio; Financial Interests, Personal, Expert Testimony: Exscientia; Financial Interests, Institutional, Invited Speaker: AstraZeneca, Roche, GSK, Genmab, Immunogen; Financial Interests, Institutional, Funding: Seagen, Clovis; Financial Interests, Institutional, Other, Co-investigator: Novartis; Non-Financial Interests, Personal, Principal Investigator: AstraZeneca; Other, Personal, Other, Travel support for conference: AstraZeneca.