This article is more than 5 years old. Information may no longer be current.
IV and IP chemo delivered to abdomen improves survival in ovarian cancer patients
A new combination therapy can improve survival for women after optimal debulking of advanced-stage ovarian cancer, according to a recent study.
Delivering IV paclitaxel along with intraperitoneal (IP) cisplatin and paclitaxel is more effective than the common IV paclitaxel-cisplatin combination. The new method can increase survivability by more than one year.
“In our trial, women who received part of their chemotherapy via an IP route had a median survival time 16 months longer than women who received only IV chemotherapy,” said Deborah Armstrong, MD, medical oncologist and associate professor at Johns Hopkins Kimmel Cancer Center in Baltimore.
|
| |
Source: NCI |
Armstrong and colleagues evaluated therapeutic response in 429 patients with stage III ovarian cancer or primary peritoneal carcinoma. Residual masses were no greater than 1 cm at initiation of chemotherapy. They randomized all patients to receive either 135 mg/m2 of IV paclitaxel over a 24-hour period followed by, on day 2, 75 mg/m2 of IV cisplatin, or 100 mg/m2 of IP cisplatin and 60 mg/m2 of IP paclitaxel on day 8. Researchers administered treatment every three weeks for six cycles, according to The New England Journal of Medicine study.
Only 42% of the IP group completed the full treatment regimen; however, that group had a median progression-free survival of 23.8 months (P = .05) compared with the IV group who had a median progression-free survival of 18.3 months. The IV group had a 49.7-month overall survival compared with 65.6-month overall survival in the IP group (P = .03).
Women in the IP group did not complete the six-week treatment primarily because of complications with the abdominal catheter. Additionally, the IP group had more adverse events. Quality of life was significantly worse for patients in the IP group before cycle 4 and three to six weeks after treatment. Grade-3 and -4 pain, fatigue and hematological, gastrointestinal, metabolic and neurologic toxic effects were more common in the IP group than in the IV group (P < .001). Most adverse events were temporary; one year after treatment, women in both study groups reported the same quality of life.
“IP therapy is not a new treatment approach, but it has not been widely accepted as the gold standard for women with ovarian cancer,” Armstrong said. “There has been a prejudice against IP therapy in ovarian cancer because it’s an old idea. It requires skill and experience for the surgery and for the chemotherapy, and it’s more complicated than IV therapy.
“But now we have firm data showing that we should use a combination of IP and IV chemotherapy in most women with advanced ovarian cancer who have had successful surgery to remove the bulk of their tumor,” she said.
Beth Y. Karlan, MD, president of the Society of Gynecologic Oncologists and director of gynecologic oncology and the Gilda Radner Cancer Detection Program at Cedars-Sinai Medical Center in Los Angeles, said, “For most women who have had successful surgical removal of tumors to less than 1 cm in size, we now know that the longest survival may be achieved by giving their chemotherapy directly into the abdomen.” – by Mark Palacio
For more information:
- Armstrong DK, Bundy B, Wenzel L, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354:34-43.