Outcomes in older patients with metastatic epithelial ovarian cancer: Are we providing equitable care? (600)

Objectives: Treatment of older patients (pts) with epithelial ovarian cancer (EOC) can be challenging as they often present with more comorbid conditions in advanced stages of the disease. Striking the correct balance between chemotherapy (chemo) tolerability and optimal surgical outcomes is difficult. Prior studies demonstrate that older pts more frequently undergo interval cytoreductive surgery (CRS) and are treated with monotherapy platinum chemo, resulting in worse outcomes. Further study is needed to better delineate treatment strategies to minimize morbidity and maximize survival for elderly patients with advanced EOC. This study aimed to compare the five-year survival outcomes of primary versus interval CRS for patients ≤65 versus >65 years with advanced EOC. Methods: We performed an IRB-approved, single-institution, retrospective study. Pts with a history of stage III/IV EOC who underwent both CRS and chemo between 1998 and 2020 were identified. Demographic and clinical data were extracted. Primary variables of interest included age at diagnosis (<65 vs >65 years) and whether they underwent primary CRS or interval CRS. Descriptive statistics, univariate analysis, Kaplan-Meier methods, and Cox proportional hazards models were used for statistical analyses. Results: A total of 226 pts were retrospectively identified who were treated with chemo and CRS for EOC. Pts who underwent interval CRS were on average older (p=0.02), more frequently non-White (p=0.01), had a higher grade and higher stage of disease (p<0.05), and were less frequently treated with platinum-containing doublets (p<0.05). Seventy-eight pts were identified as >65 years of age at the time of diagnosis, and of these, 50 (64.1%) underwent primary CRS. This rate of primary CRS was not significantly different than the 113 (76.4%) pts aged <65 years who underwent primary CRS (p=0.06). Rates of optimal CRS were not significantly different between the two cohorts at 68.5% (<65) and 55.4% (>65). However, younger pts who underwent interval CRS had a 5-year survival probability of 40.5% (24.7-66.1%) compared to 72.0% (63.5-81.7%) for those who underwent primary CRS with a hazard ratio of 2.96 (1.69-5.19, p<0.05). There was no significant difference in 5-year survival probability in those pts who were >65 between interval CRS and primary CRS at 39.6% (23.4-67.0%) and 55.0% (41.9-72.1%), respectively, with a hazard ratio of 1.22 (0.65-2.29, p=0.54). Conclusions: Primary CRS resulted in improved survival in younger pts when compared to interval CRS; however, 5-year survival rates were no different in those >65 years of age at diagnosis. Pts who underwent interval CRS were more frequently non-White and were less frequently treated with platinum-containing doublets, which require further investigation. Studies are currently underway to assess perioperative outcomes and factors associated with the timing of CRS with chemotherapy tolerability in older pts to ensure delivery of equitable care. Objectives: Treatment of older patients (pts) with epithelial ovarian cancer (EOC) can be challenging as they often present with more comorbid conditions in advanced stages of the disease. Striking the correct balance between chemotherapy (chemo) tolerability and optimal surgical outcomes is difficult. Prior studies demonstrate that older pts more frequently undergo interval cytoreductive surgery (CRS) and are treated with monotherapy platinum chemo, resulting in worse outcomes. Further study is needed to better delineate treatment strategies to minimize morbidity and maximize survival for elderly patients with advanced EOC. This study aimed to compare the five-year survival outcomes of primary versus interval CRS for patients ≤65 versus >65 years with advanced EOC. Methods: We performed an IRB-approved, single-institution, retrospective study. Pts with a history of stage III/IV EOC who underwent both CRS and chemo between 1998 and 2020 were identified. Demographic and clinical data were extracted. Primary variables of interest included age at diagnosis (<65 vs >65 years) and whether they underwent primary CRS or interval CRS. Descriptive statistics, univariate analysis, Kaplan-Meier methods, and Cox proportional hazards models were used for statistical analyses. Results: A total of 226 pts were retrospectively identified who were treated with chemo and CRS for EOC. Pts who underwent interval CRS were on average older (p=0.02), more frequently non-White (p=0.01), had a higher grade and higher stage of disease (p<0.05), and were less frequently treated with platinum-containing doublets (p<0.05). Seventy-eight pts were identified as >65 years of age at the time of diagnosis, and of these, 50 (64.1%) underwent primary CRS. This rate of primary CRS was not significantly different than the 113 (76.4%) pts aged <65 years who underwent primary CRS (p=0.06). Rates of optimal CRS were not significantly different between the two cohorts at 68.5% (<65) and 55.4% (>65). However, younger pts who underwent interval CRS had a 5-year survival probability of 40.5% (24.7-66.1%) compared to 72.0% (63.5-81.7%) for those who underwent primary CRS with a hazard ratio of 2.96 (1.69-5.19, p<0.05). There was no significant difference in 5-year survival probability in those pts who were >65 between interval CRS and primary CRS at 39.6% (23.4-67.0%) and 55.0% (41.9-72.1%), respectively, with a hazard ratio of 1.22 (0.65-2.29, p=0.54). Conclusions: Primary CRS resulted in improved survival in younger pts when compared to interval CRS; however, 5-year survival rates were no different in those >65 years of age at diagnosis. Pts who underwent interval CRS were more frequently non-White and were less frequently treated with platinum-containing doublets, which require further investigation. Studies are currently underway to assess perioperative outcomes and factors associated with the timing of CRS with chemotherapy tolerability in older pts to ensure delivery of equitable care.