Fabien Tinquaut1, Gilles Freyer2, Franck Chauvin1, Nicolas Gane3, Eric Pujade-Lauraine4, Claire Falandry5. 1. Hygee Center, Regional center for Cancer Prevention, Saint Priest en Jarez, France. 2. Medical Oncology unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Bénite, France. 3. ARCAGY (Association de Recherche sur le CAncers Gynécologiques), Paris, France. 4. Unité Cancer de la Femme et Recherche Clinique, Hôpitaux Universitaires Paris Centre, site Hôtel-Dieu, Université Paris Descartes, Paris, France. 5. Geriatrics and Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France. Electronic address: claire.falandry@chu-lyon.fr.
Abstract
BACKGROUND: The GINECO led three multicentric prospective phase II studies, Elderly Woman Ovarian Trials 1 (EWOT1), EWOT2, and EWOT3, to evaluate the impact of geriatric covariates on the outcome of elderly patients treated with six courses of first-line chemotherapy for FIGO stage IIIIV ovarian cancer. This pooled analysis was designed to evaluate the validity of the geriatric vulnerability parameters identified in EWOT3 (Falandry et al., 2013). PATIENTS AND METHODS: From 1997 to 2011, 266 patients were recruited: 83 in EWOT1, 72 in EWOT2, and 111 in EWOT3, which evaluated respectively a 4-weekly carboplatin-cyclophosphamide regimen, a 3-weekly standard carboplatin-paclitaxel doublet and a carboplatin monotherapy. All patients were analyzed in this pooled analysis for treatment completion, toxicity, and overall survival. RESULTS: The global treatment completion rate was 73% and ranged from 68% in EWOT2 to 74% in EWOT3. Toxicities were generally manageable: neutropenia was more frequent in EWOT2 and thrombopenia in EWOT1 and EWOT3. In multivariate analysis, covariates associated with decreased survival were: being "depressed" according to the investigators' assessment, hypoalbuminemia <35g/L, and FIGO stage IV. In addition, a Hospital Anxiety and Depression Scale (HADS) score>14 and Instrumental Activities of Daily Living (IADL) score<25 confirmed a deleterious impact in the EWOT2+EWOT3 population subanalysis. CONCLUSIONS: Despite moderate heterogeneity among the studies, this pooled analysis confirmed the deleterious effects on overall survival of emotional disorders ("depressed", as assessed by investigators or the HADS score), and decreased functionality (IADL score), in addition to FIGO stage.
BACKGROUND: The GINECO led three multicentric prospective phase II studies, Elderly Woman Ovarian Trials 1 (EWOT1), EWOT2, and EWOT3, to evaluate the impact of geriatric covariates on the outcome of elderly patients treated with six courses of first-line chemotherapy for FIGO stage IIIIV ovarian cancer. This pooled analysis was designed to evaluate the validity of the geriatric vulnerability parameters identified in EWOT3 (Falandry et al., 2013). PATIENTS AND METHODS: From 1997 to 2011, 266 patients were recruited: 83 in EWOT1, 72 in EWOT2, and 111 in EWOT3, which evaluated respectively a 4-weekly carboplatin-cyclophosphamide regimen, a 3-weekly standard carboplatin-paclitaxel doublet and a carboplatin monotherapy. All patients were analyzed in this pooled analysis for treatment completion, toxicity, and overall survival. RESULTS: The global treatment completion rate was 73% and ranged from 68% in EWOT2 to 74% in EWOT3. Toxicities were generally manageable: neutropenia was more frequent in EWOT2 and thrombopenia in EWOT1 and EWOT3. In multivariate analysis, covariates associated with decreased survival were: being "depressed" according to the investigators' assessment, hypoalbuminemia <35g/L, and FIGO stage IV. In addition, a Hospital Anxiety and Depression Scale (HADS) score>14 and Instrumental Activities of Daily Living (IADL) score<25 confirmed a deleterious impact in the EWOT2+EWOT3 population subanalysis. CONCLUSIONS: Despite moderate heterogeneity among the studies, this pooled analysis confirmed the deleterious effects on overall survival of emotional disorders ("depressed", as assessed by investigators or the HADS score), and decreased functionality (IADL score), in addition to FIGO stage.
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