Adherence to treatment recommendations and outcomes for women with ovarian cancer at first recurrence

Objective Treatment selection for recurrent ovarian cancer is typically based on the duration of time between the completion of adjuvant, platinum-based therapy and the time of recurrence, the platinum free interval (PFI). We examined the use of, and outcomes associated with platinum-based chemotherapy based on the PFI in women with recurrent ovarian cancer. Methods The Surveillance, Epidemiology, and End Results-Medicare database was used to identify women aged > 65 years with epithelial ovarian cancer who underwent surgery and platinum-based chemotherapy and who developed a recurrence > 3 months after the completion of adjuvant therapy. Patients were stratified by PFI into 3 groups: PFI < 6 months, PFI 7–12 months, and PFI > 12 months. Multivariable models were used to examine predictors of use of platinum-based therapy and survival for each group. Results A total of 2369 patients were identified. In women with a PFI of ≤ 6 months, treatment consisted of platinum-based combination therapy in 28.2%, single agent platinum in 5.2% and non-platinum therapy in 66.6%. Corresponding rates of these treatments among women with a PFI of 7–12 months were 39.7%, 12.4% and 47.9%, respectively; the rates were 57.6%, 13.2% and 29.3% in those with a PFI of > 12 months, respectively. Median survival was 13, 18, and 27 months for patients with a PFI of ≤ 6 months, 7–12 months, and > 12 months, respectively (P < 0.0001). For all three groups, platinum combination therapy was associated with decreased risk of death compared to non‑platinum based therapy. Conclusion Platinum free interval is a strong predictor of survival in elderly women with recurrent ovarian cancer. There is widespread variation in treatment selection for women with recurrent ovarian cancer with many women receiving non-guideline based regimens.