Poor performance status (PS) is an indication for an aggressive approach to neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer (EOC)

• Despite a poor PS, EOC patients benefit from upfront platinum-based chemotherapy.
• Carboplatin with paclitaxel should be treatment of choice even in patients with poor PS.
• Patients with improving PS in the first 2 cycles should continue with chemotherapy.

BackgroundSome guidelines suggest that poor performance status (PS) is a contraindication to 1st line chemotherapy. Poor PS is a known adverse prognostic factor in advanced epithelial ovarian cancer (EOC). We show in this retrospective analysis that 1st line chemotherapy in this patient group is not only safe but is associated with good outcomes.Patients and methodsA retrospective review of 114 patients with stage III/IV EOC, who presented with a PS ≥ 3 at diagnosis and treated as inpatients with upfront platinum-based chemotherapy between 2000 and 2013, at the Royal Marsden Hospital, was conducted. The association between clinical parameters and the likelihood of completion of chemotherapy and overall survival (OS) was assessed.Results66% of patients completed ≥ 6 cycles of platinum-based chemotherapy. Prognostic factors for completion of chemotherapy were improvement of PS during hospital stay (p < 0.001) and doublet-chemotherapy with carboplatin/paclitaxel compared to single-agent carboplatin (p = 0.004). A negative trend for completion of treatment was seen for patients with low albumin (< 25 g/l) and low CA125 levels at baseline. The median OS for all patients was 13.1 months (95% CI: 10.4–15.8) and 21.2 months (95% CI: 16.5–25.8) for those who completed 6 cycles of chemotherapy.ConclusionUpfront platinum-based chemotherapy is feasible, beneficial and tolerable for the majority of patients with advanced EOC and poor PS. Guidelines suggesting that best supportive care is the preferred option for poor PS patients with solid tumours should be revised to exclude those with advanced EOC. An aggressive approach utilising neoadjuvant carboplatin plus paclitaxel should be regarded as standard of care.