Targeted Therapies in the Management of Ovarian Cancer: A Focus on Older Patients.

Ovarian cancer is one of the most common gynaecological malignancies and one of the leading causes of cancer mortality in women. The standard of care for ovarian cancer is maximal de-bulking surgery followed by adjuvant platinum-based chemotherapy. The median age at diagnosis is 63 years, yet older patients are under-represented in clinical trials. Historically, 65 years of age has been used as a definition of elderly; however, such an age cut-off encompasses a highly heterogeneous population with regards to comorbidity, functional status, and cognition. New targeted therapies are emerging in the treatment of ovarian cancer, with the most experience being with bevacizumab and poly(ADP-ribose) polymerase (PARP) inhibitors. These agents have led to significant improvements in progression-free survival in selected trial populations. Whilst evidence for the use of these agents in older women is limited, there appears to be no signal for any difference in efficacy. The potential risk of increased toxicity in older adults with comorbidities is explored using the data available. More evidence is needed in the application of newer targeted therapies in older women with ovarian cancer, and improved accrual of older patients to clinical trials is required.