Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer – An NRG oncology/Gynecologic Oncology Group study

Purpose A simple measure to predict chemotherapy tolerance in elderly patients would be useful. We prospectively tested the association of baseline Instrumental Activities of Daily Living (IADL) score with ability to complete 4 cycles of first line chemotherapy without dose reductions or > 7 days delay in elderly ovarian cancer patients. Patients and methods Patients' age ≥ 70 along with their physicians chose between two regimens: CP (Carboplatin AUC 5, Paclitaxel 135 mg/m²) or C (Carboplatin AUC 5), both given every 3 weeks either after primary surgery or as neoadjuvant chemotherapy (NACT) with IADL and quality of life assessments performed at baseline, pre-cycle 3, and post-cycle 4. Results Two-hundred-twelve women were enrolled, 152 selecting CP and 60 selecting C. Those who selected CP had higher baseline IADL scores (p < 0.001). After adjusting for age and PS, baseline IADL was independently associated with the choice of regimen (p = 0.035). The baseline IADL score was not found to be associated with completion of 4 cycles of chemotherapy without dose reduction or delays (p = 0.21), but was associated with completion of 4 cycles of chemotherapy regardless of dose reduction and delay (p = 0.008) and toxicity, with the odds ratio (OR) of grade 3 + toxicity decreasing 17% (OR: 0.83; 95%CI: 0.72–0.96; p = 0.013) for each additional activity in which the patient was independent. After adjustment for chemotherapy regimen, IADL was also associated with overall survival (p = 0.019) for patients receiving CP. Conclusion Patients with a higher baseline IADL score (more independent) were more likely to complete 4 cycles of chemotherapy and less likely to experience grade 3 or higher toxicity.