Elderly oravian cancer patients: treatment options

INTRODUCTION. Ovarian cancer, the main cause of death among gynaecological malignancies, affects half of women in postmenopausal age. With the increase in older population, this tumor will be more frequent in elderly women, but not all the elderly patients can undertake standard treatments, due to comorbidities and less functional organ reserves. New therapeutic approaches are needed to obtain an amendable overall survival and quality of life in this kind of patients. OBJECTIVE. Our aim is to propose the best management of elderly ovarian cancer patients, taking account of biological age over chronologic age, with the aim to assure suitable treatments with a better overall survival. DISCUSSION. Carboplatin-paclitaxel doublet is the standard treatment in patients with ovarian cancer; elderly patients are less treated with this therapy, due both to comorbidities and to the major toxicity. When the standard schedule every 21 days is administered in elderly patients, dose delay or previous stop for toxicity is frequent. Furthermore, elderly are not candidate for intraperitoneal chemotherapy and HIPEC (hyperthermic intraperitoneal chemotherapy), due to highest toxicity. Chemotherapy is often the only possible choice for these patients, because a surgical debulking can be too much aggressive and associated with several morbidities. Elderly have the same chemosensitivity than younger: geriatric assessment is fundamental to screen elderly population fitting for chemotherapy, and new strategies with less toxicity have to be investigated. Older patients with ovarian cancer have been underrepresented in clinical trials, so the few clinical studies with this kind of population must be evaluated. It’s not clear whether doublets or single agents are better in the treatment of elderly ovarian cancer patients. Single agent options for elderly patients include liposomal doxorubicin, topotecan, gemcitabine and vinorelbine. Doublet combinations every 21 days have been largerly investigated, but only small clinical trials have been conducted on weekly schedule. Weekly carboplatin and paclitaxel have demonstrated an optimal compliance among elderly patients. For what concern targeted therapies, there are no elderly-specific data on PARP inhibitors, but they appear to be well tolerated, on the opposite to antiangiogenic agents, which require more caution in the older population. Metronomic chemotherapy and weekly schedules are the best solutions for elderly patients, for their efficacy and tolerability, contributing to quality of life. CONCLUSIONS. Metronomic therapy, comprising weekly schedules, can be an optimal option for elderly ovarian cancer patients. Prospective studies are needed to develop further strategies for these women.