Chemotherapy Treatment Patterns in Elderly Patients Initially Diagnosed With Advanced Ovarian Cancer

Background

Over the past decade, chemotherapy treatment for patients with advanced ovarian cancer has expanded, with platinum-based and taxane therapy remaining the backbone. Elderly patients have received little attention, and less is known about the variation and duration of agents elderly women receive for first-line, maintenance, and second-line therapy.

Patients and Methods

Using SEER linked to Medicare claims data, we identified a cohort of women (older than 65 years) with advanced epithelial ovarian cancer who received first-line and/or maintenance therapy between 2003-2009. Over the same period, we identified women who received second-line therapy. We examined the variety of cytotoxic regimens and duration of therapy.

Results

In the patient group, 10,695 patients were eligible for chemotherapy, and 5357 had evidence of receiving any chemotherapy. The first-line sample included 2509 patients, the maintenance sample included 306 patients, and the second-line sample included 1890 patients. Among first-line patients, paclitaxel and carboplatin was the most common regimen. Approximately half of the patients did not successfully complete first-line treatment. Of those eligible for maintenance therapy, about one-quarter of the patients initiated a maintenance regimen, and approximately 10% of those who initiated maintenance therapy completed at least 40 weeks. The most common second-line treatment included platinum-based and taxane therapy, if the patient was platinum-sensitive, or a single-agent anthracycline therapy otherwise.

Conclusion

Additional research should address low first-line treatment completion rates. Most patients eligible for maintenance therapy do not initiate it, and multiple treatment strategies predominate in second-line therapy. There remains a substantial unmet need in therapy options for ovarian cancer.