In Reply We appreciate the opportunity to reply to comments regarding the perhaps counterintuitive and unexpected results from our randomized clinical trial on first-line chemotherapy in vulnerable older adult patients with cancer.1
Ito and Shimomura questioned the apparently lower feasibility of carboplatin monotherapy vs carboplatin–paclitaxel combinations. Importantly, despite a less favorable hematologic profile as previously reported,2 the decreased feasibility of carboplatin monotherapy in our study1 was more linked to an excess of early tumor progression rather than excess toxicity. Tumor progression was also more frequent with carboplatin monotherapy than a carboplatin–paclitaxel doublet in the NRG Oncology/Gynecologic Oncology Group GOG273 trial.3 Although the pejorative influence on overall survival of carboplatin monotherapy vs carboplatin–paclitaxel doublets has not always been confirmed, differing outcomes between regimens may be more obvious in our trial’s older population.1 Historical studies have highlighted the overly aggressive nature of ovarian cancer in older vs younger patients4 and a trend toward more extensive tumors,5 which may need more aggressive (doublet) chemotherapy.
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Falandry C, Freyer G, Pujade-Lauraine E. What Is the Optimal Treatment for Vulnerable Older Women With Ovarian Cancer?—Reply. JAMA Oncol. 2021;7(11):1727. doi:10.1001/jamaoncol.2021.4131
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