Contribution of age to clinical trial enrollment and tolerance with ovarian cancer

Jessica Gillen, Camille Gunderson, Molly Greenwade, Michelle Rowland, Rachel Ruskin, Kai Ding, Aleia Crim, Adam Walter, Emily White, Kathleen Moore

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction Increasing age has been correlated with shorter survival in ovarian cancer patients, a finding attributed to diminished tolerance of standard therapy. Elderly patients, however, are less likely to enroll on clinical trials; thus, limited data exists to evaluate their response to front line treatment. This study describes how elderly patients on trial fared, with respect to toxicity and response, compared to younger women. Methods A retrospective cohort study was performed of ovarian cancer patients enrolled in front line chemotherapy trials at our institution between 2000 and 2013. Patients were dichotomized by age: < 70 and ≥ 70 years. Clinical, pathologic, and treatment characteristics were recorded and analyzed using SAS version 9.3. Results 336 patients were enrolled. Of these, 79 (23.5%) were ≥ 70 yrs. Demographics were similar between the two groups. Compared to patients < 70, those ≥ 70 completed a comparable number of chemotherapy cycles (p = 0.16) and had similar numbers of dose modifications (p = 0.40) and delays (p = 0.26). Both hematologic and non-hematologic toxicities occurred at similar rates as well. Age ≥ 70 (HR 1.8, 95% CI 1.27–2.54, p = 0.0009), stage III/IV (HR 3.44, 95% CI 1.08–10.95, p = 0.036), and residual disease (HR 2.63, 95% CI 1.82–3.78, p < 0.0001) were independently predictive of shorter overall survival. Conclusion Our data continues to support reports of shorter survival for older women with ovarian cancer. With physician bias removed and similar chemotherapy tolerance noted, our study suggests that inherent tumor biology may be a significant contributor. Further research is needed to identify the mechanisms which contribute to the inequality that age imposes on outcomes.

Original languageEnglish (US)
Pages (from-to)32-36
Number of pages5
JournalGynecologic Oncology
Volume145
Issue number1
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

Fingerprint

Ovarian Neoplasms
Clinical Trials
Drug Therapy
Survival
Cohort Studies
Therapeutics
Retrospective Studies
Demography
Physicians
Research
Neoplasms

Keywords

  • Chemotherapy tolerance
  • Older women
  • Ovarian cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Gillen, J., Gunderson, C., Greenwade, M., Rowland, M., Ruskin, R., Ding, K., ... Moore, K. (2017). Contribution of age to clinical trial enrollment and tolerance with ovarian cancer. Gynecologic Oncology, 145(1), 32-36. https://doi.org/10.1016/j.ygyno.2016.12.023

Contribution of age to clinical trial enrollment and tolerance with ovarian cancer. / Gillen, Jessica; Gunderson, Camille; Greenwade, Molly; Rowland, Michelle; Ruskin, Rachel; Ding, Kai; Crim, Aleia; Walter, Adam; White, Emily; Moore, Kathleen.

In: Gynecologic Oncology, Vol. 145, No. 1, 01.04.2017, p. 32-36.

Research output: Contribution to journalArticle

Gillen, J, Gunderson, C, Greenwade, M, Rowland, M, Ruskin, R, Ding, K, Crim, A, Walter, A, White, E & Moore, K 2017, 'Contribution of age to clinical trial enrollment and tolerance with ovarian cancer', Gynecologic Oncology, vol. 145, no. 1, pp. 32-36. https://doi.org/10.1016/j.ygyno.2016.12.023
Gillen, Jessica ; Gunderson, Camille ; Greenwade, Molly ; Rowland, Michelle ; Ruskin, Rachel ; Ding, Kai ; Crim, Aleia ; Walter, Adam ; White, Emily ; Moore, Kathleen. / Contribution of age to clinical trial enrollment and tolerance with ovarian cancer. In: Gynecologic Oncology. 2017 ; Vol. 145, No. 1. pp. 32-36.
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AB - Introduction Increasing age has been correlated with shorter survival in ovarian cancer patients, a finding attributed to diminished tolerance of standard therapy. Elderly patients, however, are less likely to enroll on clinical trials; thus, limited data exists to evaluate their response to front line treatment. This study describes how elderly patients on trial fared, with respect to toxicity and response, compared to younger women. Methods A retrospective cohort study was performed of ovarian cancer patients enrolled in front line chemotherapy trials at our institution between 2000 and 2013. Patients were dichotomized by age: < 70 and ≥ 70 years. Clinical, pathologic, and treatment characteristics were recorded and analyzed using SAS version 9.3. Results 336 patients were enrolled. Of these, 79 (23.5%) were ≥ 70 yrs. Demographics were similar between the two groups. Compared to patients < 70, those ≥ 70 completed a comparable number of chemotherapy cycles (p = 0.16) and had similar numbers of dose modifications (p = 0.40) and delays (p = 0.26). Both hematologic and non-hematologic toxicities occurred at similar rates as well. Age ≥ 70 (HR 1.8, 95% CI 1.27–2.54, p = 0.0009), stage III/IV (HR 3.44, 95% CI 1.08–10.95, p = 0.036), and residual disease (HR 2.63, 95% CI 1.82–3.78, p < 0.0001) were independently predictive of shorter overall survival. Conclusion Our data continues to support reports of shorter survival for older women with ovarian cancer. With physician bias removed and similar chemotherapy tolerance noted, our study suggests that inherent tumor biology may be a significant contributor. Further research is needed to identify the mechanisms which contribute to the inequality that age imposes on outcomes.

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