First Insight Of A Tailoring Chemotherapy Intensity Regimen In A Real Life Cohort Of Elderly Patients With Ovarian Cancer: The Circe Study

Introduction/Background Women aged ≥65 represent nearly 50% of ovarian cancer (OC) patients (pts). However, elderly OC pts are less likely to receive optimal treatment. Furthermore, they are significantly under-represented in clinical trials and multidimensional geriatric assessment is still underused. The present study aims to provide an overview of real-life treatment strategies for elderly advanced-OC pts and to investigate clinico-pathological features that could potentially drive choice of first-line treatment. Methodology A retrospective analysis was conducted on a consecutive series of 45 OC pts aged ≥69 treated with first-line chemotherapy (1L_CT) from 2011 to 2018 at CRO Aviano National Cancer Institute (Italy). Factors associated with treatment choice and rate of adverse events were investigated through Fisher-exact test; differences in progression free survival (PFS) and overall survival (OS) were tested by log-rank test. Results 67% of pts received 1L_CT with a standard carboplatin-paclitaxel combination (CPC). Conversely, 33% received a monotherapy (MT) (31% with carboplatin, 2% with paclitaxel). ECOG PS ≥1 was the only factor significantly associated with choice of MT (P=0.021). No differences were observed between CPC and CPC with dose reductions (CPCdr), neither in terms of PFS (HR=1.29 P=0.59) nor OS (HR=1.40 P=0.56). On the other hand, MT was associated with shorter PFS (HR=4.35 P=0.001) and OS (HR=4.48 P=0.005). No differences in treatment discontinuation rate, neutropenia, thrombocytopenia, neuropathy, constipation, diarrhoea and asthenia in CPC, CPCdr and MT were detected (P>0.05). Conclusion The present study confirms CPC as the standard first-line chemotherapy also in advanced OC elderly pts and suggests that CPCdr is preferable to MT regimens. Notwithstanding the limitations due to the small sample size, the evaluated regimens showed a comparable toxicity profile. Notably, clinical decision-making was mainly driven by PS ECOG highlighting the pivotal role of multidimensional geriatric assessment for pts stratification. Further prospective studies are needed to investigate improved tailored strategies. Disclosure Nothing to disclose.