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GYNECOLOGIC CANCER Managing Ovarian Cancer in the Older Woman: How to Best Select and Sequence Surgery and Chemotherapy for Optimal Outcome CHAIR Linda R. Duska, MD University of Virginia Charlottesville, VA SPEAKERS Kathleen N. Moore, MD University of Oklahoma Oklahoma City, OK William P. Tew, MD Memorial Sloan Kettering Cancer Center New York, NY
EPITHELIAL OVARIAN CANCER IN OLDER WOMEN Epithelial Ovarian Cancer in Older Women: Defining the Best Management Approach Linda R. Duska, MD, William P. Tew, MD, and Kathleen N. Moore, MD OVERVIEW Epithelial ovarian cancer is a cancer of older women. In fact, almost half of women diagnosed with ovarian cancer will be older than age 64, and 25% will be older than age 74. Therefore, it is crucial to examine the available data in older populations to optimize the therapeutic approach without negatively affecting the quality of life permanently. Unfortunately, little prospective data are available in this under-represented population of women. Although ovarian cancer traditionally has been approached with aggressive cytoreductive surgery, older patients may benefit from a less aggressive surgical approach and, in some cases, may be candidates for neoadjuvant chemotherapy followed by an interval cytoreduction. Modalities do exist for assessing an older woman’s ability to tolerate surgery and chemotherapy, and these tools should be familiar to clinicians who are caring for this population of women in making treatment decisions. Ongoing planned trials to evaluate pretreatment assessment for older patients will provide objective, feasible, clinical tools for applying our treatment-based knowledge. Future trials of both surgery and chemotherapy, including a focus on the sequence of these two treatment modalities, are crucial to guide decision making in this vulnerable population and to improve outcomes for all. Close to half (45%) of women diagnosed with ovarian cancer will be older than age 64, and 25% will be older than age 74 (20.7%, age 65 to 74; 16.6%, age 75 to 84; and 8.1%, older than age 84). 1 The mean age at diagnosis of ovarian cancer is 63 years. 1,2 In addition, the percentage of older women with ovarian cancer is expected to increase in the coming decades as our population ages and life expectancy improves. 3,4 Unfortunately, as the age of the patients increases, cancer outcomes steadily worsen. One report showed age-standardized relative survival rates at 1 year of 57% for women age 65 to 69, 43% to 45% for those age 70 to 79, and 25% to 33% for those age 80 to 99. 5 There have been various theories put forward to account for the decreased survival in older women, including the following: (1) more aggressive tumor biology, including higher grade and more advanced stage, (2) inherent resistance to chemotherapy, (3) individual patient factors, such as multiple concurrent medical problems, functional decline, and malnutrition leading to greater anticipated treatment toxicity, and (4) physician and health care biases toward older adults that lead to inadequate surgery, and suboptimal chemotherapy. 6 To improve the outcomes of older women with ovarian cancer, we need to develop better decision aids to discriminate those patients who will and will not tolerate standard cytoreductive surgery (CRS) and chemotherapy. Our trials cannot continue to focus exclusively on younger, fıt women and the healthiest subsection of older women. In the Southwest Oncology Group (SWOG) analysis of data on 16,396 patients enrolled in 164 trials during the 1990s, patients older than age 65 accounted for only 30% of all included patients. 7 Similarly, in a recent Surveillance, Epidemiology, and End Results (SEER) survey, only 9% of patients older than age 75 who had cancer were included in clinical trials of new therapies. 8 With a focus on improving under-represented populations, cooperative groups in the U.S. (Elderly Working Group in the NRG Gynecologic Oncology Group [GOG]) and Europe (Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, GINECO) are developing trials specifıc for older women with gynecologic cancer. In this review, we will discuss currently available data regarding results of surgery and chemotherapy in the older woman with ovarian cancer as well as review geriatric assessment (GA) tools being developed to aid decision making regarding both surgical and chemotherapeutic interventions. Ovarian Cancer Surgery in Older Women The data for surgery in epithelial ovarian cancer (EOC), although retrospective, is clear: patients with advanced (stages III to IV disease) will experience an improved overall survival if they undergo an optimal CRS. 9,10 The meaning of optimal has changed over time, with an accepted current defınition in the platinum era of less than 1 cm of residual disease. 11 Most recently, it has been suggested that no visible residual should be the goal of a cytoreductive surgery. The improved survival From the University of Virginia, Charlottesville, VA; Memorial Sloan Kettering Cancer Center, New York NY; University of Oklahoma, Oklahoma City, OK. Disclosures of potential conflicts of interest are found at the end of this article. Corresponding author: Linda R. Duska, MD, University of Virginia, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, PO Box 800712, Charlottesville, VA 22908; email: lduska@virginia.edu. © 2015 by American Society of Clinical Oncology. asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK e311
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AMERICAN SOCIETY OF CLINICAL ONCOLO
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Controversies in Neoadjuvant Therap
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2015 ASCO Annual Meeting Disclosure
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2015 Educational Book Expert Panel
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James Marshall, PhD Roswell Park Ca
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KLEPIN, RODIN, AND HURRIA plan was
Page 760 and 761:
KLEPIN, RODIN, AND HURRIA patient-s
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KLEPIN, RODIN, AND HURRIA 62. Blanc
Page 764 and 765:
PERIPHERAL NEUROTOXICITY IN CANCER
Page 766 and 767:
Page 768 and 769:
Page 770 and 771:
Page 772 and 773:
PARTRIDGE, JACOBSEN, AND ANDERSEN C
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PARTRIDGE, JACOBSEN, AND ANDERSEN c
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PARTRIDGE, JACOBSEN, AND ANDERSEN w
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PARTRIDGE, JACOBSEN, AND ANDERSEN v
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LESLIE R. SCHOVER Sexual Healing in
Page 782 and 783:
LESLIE R. SCHOVER tinuous ADT in pr
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LESLIE R. SCHOVER 12. Potosky AL, H
Page 786 and 787:
CATHERINE H. VAN POZNAK TABLE 1. Wo
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CATHERINE H. VAN POZNAK (tamoxifen,
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CATHERINE H. VAN POZNAK TABLE 3. FD
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CATHERINE H. VAN POZNAK premenopaus
Page 794 and 795:
SHARI GOLDFARB KEY POINTS Brea
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SHARI GOLDFARB and friction with va
Page 798 and 799:
SHARI GOLDFARB importance both duri
Page 800 and 801:
PATIENT AND SURVIVOR CARE Moving Su
Page 802 and 803:
MAYER ET AL TABLE 1. Quality Metric
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MAYER ET AL to enhance the quality
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MAYER ET AL FIGURE 2. (A) Infertili
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MAYER ET AL efıcial suggests that
Page 810 and 811:
PATIENT AND SURVIVOR CARE The Chall
Page 812 and 813:
BRUERA AND PAICE Choice of Opioid a
Page 814 and 815:
BRUERA AND PAICE toxicity and proce
Page 816 and 817:
BRUERA AND PAICE effective. Basic s
Page 818 and 819:
PEDIATRIC ONCOLOGY Real-Time Molecu
Page 820 and 821:
CARROLL, RAETZ, AND MEYER KEY POINT
Page 822 and 823:
CARROLL, RAETZ, AND MEYER most are
Page 824 and 825:
CARROLL, RAETZ, AND MEYER markers a
Page 826 and 827:
PEDIATRIC ONCOLOGY Translating Surv
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REDUCING THE BURDEN OF LATE EFFECTS
Page 830 and 831:
Page 832 and 833:
Page 834 and 835:
Page 836 and 837:
PROFESSIONAL DEVELOPMENT The Challe
Page 838 and 839:
ADVANCES IN WEBSITE INFORMATION RES
Page 840 and 841:
Page 842 and 843:
Page 844 and 845:
Page 846 and 847:
COMMUNICATION AND TECHNOLOGY: IT’
Page 848 and 849:
Page 850 and 851:
Page 852 and 853:
PATIENT-REPORTED OUTCOMES IN ONCOLO
Page 854 and 855:
PATIENT-REPORTED OUTCOMES IN ONCOLO
Page 856 and 857:
PROFESSIONAL DEVELOPMENT Trends, An
Page 858 and 859:
CLINICAL ONCOLOGY PRACTICE 2015 FIG
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CLINICAL ONCOLOGY PRACTICE 2015 (6.
Page 862 and 863:
CLINICAL ONCOLOGY PRACTICE 2015 Pro
Page 864 and 865:
ADJUVANT/NEOADJUVANT MEDICAL THERAP
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Page 868 and 869:
Page 870 and 871:
INDICATIONS FOR ADJUVANT RADIATION
Page 872 and 873:
Page 874 and 875:
Page 876 and 877:
Page 878 and 879:
SARCOMA Latest Advances in Systemic
Page 880 and 881:
SYSTEMIC THERAPY FOR OSTEOSARCOMA A
Page 882 and 883:
SYSTEMIC THERAPY FOR OSTEOSARCOMA A
Page 884 and 885:
RETHINKING TREATMENT FOR CHONDROSAR
Page 886 and 887:
Page 888 and 889:
Page 890 and 891:
Page 892 and 893:
BONE SARCOMAS IN ADULTS local disea
Page 894 and 895:
BONE SARCOMAS IN ADULTS structure a
Page 896 and 897:
SARCOMA Well-Differentiated and Ded
Page 898 and 899:
ABBAS MANJI ET AL ticular region. 7
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ABBAS MANJI ET AL MYXOID (ROUND CEL
Page 902 and 903:
ABBAS MANJI ET AL versus doxorubici
Page 904 and 905:
SHLUSH AND HERSHKOVITZ Clonal Evolu
Page 906 and 907:
SHLUSH AND HERSHKOVITZ FIGURE 1. Ti
Page 908 and 909:
TUMOR BIOLOGY New Strategies to Und
Page 910 and 911:
KNAPP, DHAWAN, AND OSTRANDER in dog
Page 912 and 913:
KNAPP, DHAWAN, AND OSTRANDER TABLE
Page 914 and 915:
KNAPP, DHAWAN, AND OSTRANDER 14. Fe
Page 916 and 917:
SOURBIER, SRINIVASAN, AND LINEHAN M
Page 918 and 919:
SOURBIER, SRINIVASAN, AND LINEHAN F
Page 920 and 921:
SOURBIER, SRINIVASAN, AND LINEHAN T
Page 922:
Author Index Abbas Manji, Gulam ...
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