BACKGROUND: Over the past decade, chemotherapy treatment for patients with advanced ovarian cancer has expanded, with platinum-based and taxane therapy remaining the backbone. Elderly patients have received little attention, and less is known about the variation and duration of agents elderly women receive for first-line, maintenance, and second-line therapy.
PATIENTS AND METHODS: Using SEER linked to Medicare claims data, we identified a cohort of women (older than 65 years) with advanced epithelial ovarian cancer who received first-line and/or maintenance therapy between 2003-2009. Over the same period, we identified women who received second-line therapy. We examined the variety of cytotoxic regimens and duration of therapy.
RESULTS: In the patient group, 10,695 patients were eligible for chemotherapy, and 5357 had evidence of receiving any chemotherapy. The first-line sample included 2509 patients, the maintenance sample included 306 patients, and the second-line sample included 1890 patients. Among first-line patients, paclitaxel and carboplatin was the most common regimen. Approximately half of the patients did not successfully complete first-line treatment. Of those eligible for maintenance therapy, about one-quarter of the patients initiated a maintenance regimen, and approximately 10% of those who initiated maintenance therapy completed at least 40 weeks. The most common second-line treatment included platinum-based and taxane therapy, if the patient was platinum-sensitive, or a single-agent anthracycline therapy otherwise.
CONCLUSION: Additional research should address low first-line treatment completion rates. Most patients eligible for maintenance therapy do not initiate it, and multiple treatment strategies predominate in second-line therapy. There remains a substantial unmet need in therapy options for ovarian cancer.
