Is age a barrier to the aggressive treatment of ovarian cancer with paclitaxel and carboplatin?

Objective. The objective of this study was to determine whether the toxicities associated with chemotherapy are age related in women treated for ovarian cancer. Methods. Patients with stage II-IV epithelial ovarian cancer underwent cytoreductive surgery. Adjunctive therapy was given to each patient consisting of intravenous (IV) paclitaxel 175 mg/m² over 3 h with a subsequent 30-min IV infusion of carboplatin. Carboplatin dose was calculated to achieve a targeted area under the curve (AUC) of 5.0-7.5. Treatment was repeated at 21- to 28-day intervals for six cycles. Toxicities were graded after each dose of chemotherapy. Results were analyzed using the Wilcoxon rank sum test and log likelihood ratio to compare toxicities in women age <60 years old to women ≥60 years old. Results. Fifty-three women, 22 of whom were ≥60 years old, were treated with 309 cycles of chemotherapy. Forty- eight patients (92%) completed all six cycles. AUC dosing of carboplatin was equivalent for both groups. Carboplatin dose reduction occurred in 75% of patients for grade 4 neutropenia or thrombocytopenia. No patient required a reduction in the paclitaxel dose. Neutropenia was less frequent in women ≥60 years old than in women <60 years old (P = 0.02). There was no difference between women <60 years old and women ≥60 years old in the incidence of anemia, thrombocytopenia, or the use of growth factors. A 68% complete clinical response rate was observed in women ≥60 years old compared to a 74% complete response rate for women under age 60 (P = 0.22). Conclusion. Age is not a barrier to the aggressive treatment of ovarian cancer with this regimen of paclitaxel and carboplatin.