Résumé
Introduction/BackgroundOlder patients with advanced ovarian cancer (AOC) have a poor survival. EWOC-1 study showed that carboplatin AUC5 monotherapy (C) was associated with 2.79-fold worse survival compared to carboplatin-paclitaxel (CP) combination in frail older patients. MITO7 study provided exploratory data in favor of weekly CP (wCP) compared to standard CP (sCP) in patients aged ≥70 years. A post hoc study on ICON7 database argued for a higher benefit of bevacizumab (Bev) in chemo-resistant tumors. Confirming the data in a real life database is fundamental to confirm results observed in randomized trials when exploration questioned the frailty.MethodologyOn the Unicancer ESME-OVR national database (NCT03275298) were analyzed in patients in first line FIGO stages III-IV high grade AOC the impact of age, chemotherapy regimens and Bev exposure on overall survival.Results4686 patients were included, 888 had bevacizumab (≥70: 253); 2583 had sCP (≥70: 570); 171 had C (≥70: 150); 379 had weekly CP (≥70: 132). Median follow-up was 64.9 months, median OS 61.3 months (95%CI: 58.0–63.8). In patients aged ≥70, OS was 43.8 months (95%CI: 40.5–47.0), HR[≥70]: 1.74 (95%CI: 1.59–1.90), p<.001); C was associated with a worse outcome (reference: sCP): HR[C,≥70]: 1.61 (95%CI: 1.29–2.00); HR[wCP,≥70]: 0.96 (95%CI: 0.73–1.27), p≤.001. In patients treated with sCP or wCP, the impact of older age persisted at a lesser extent: HR[≥70,sCP/wCP]: 1.64 (95%CI: 1.46–1.84), p<.0001. Bev tended to improve survival in older patients (HR[Bev,≥70]: 0.80 (95%CI: 0.64–1.01), p=0.057), but not in younger patients (HR[Bev,<70]: 0.96 (95%CI: 0.84–1.10), p=0.596).ConclusionIn this real-world population, C was associated in univariate to a higher risk of death, confirming the conclusions of EWOC-1 trial. When considering sCP/wCP treatment, worse age impact persisted with a 1.64-fold risk of premature death. Bev tended to improve survival raising the possible role of chemo-resistance in the poorer outcome of older patients.