Chemotherapy for ovarian cancer in the older adult

The treatment of epithelial ovarian cancer in the older adult presents many challenges. The standard of care is cytoreductive surgery with the aim of achieving minimal residual disease. Surgery is then usually followed by six cycles of platinum-taxane chemotherapy. Older patients often have comorbidities which limit treatment choice and increase the risk of major surgical procedures. Platinum-based chemotherapy is generally well tolerated in fit elderly patients but can result in more toxicity in patients of increasing age. Results of a recent randomized trial of neoadjuvant platinum-based chemotherapy vs upfront surgery reveal decreased toxicity and equivalent survival in patients who receive chemotherapy prior to surgery. Treatment strategies to reduce the toxicity of chemotherapy include the use of single agent carboplatin, dose reduction, and weekly scheduling. Comprehensive geriatric assessment (CGA) of older patients prior to treatment may predict for toxicity of therapy and even survival. While comprehensive assessment may be desirable, it is impractical in the clinic. A simplified screening tool to detect geriatric problems and the further need for a formal assessment is more feasible. Prospective clinical trials of therapy in the elderly patient population are needed to guide treatment decisions.