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Intraperitoneal chemotherapy improved ovarian cancer survival
Patients with advanced ovarian cancer who underwent intraperitoneal chemotherapy were 17% more likely to live longer than patients who received standard IV chemotherapy, according to long-term study results presented at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer.
Intraperitoneal chemotherapy, typically administered through a surgically implanted catheter, is an intensive treatment that directs chemotherapy to a patient’s abdomen.
The process — recommended by NCI for women who have had optimal surgery — places a high concentration of cancer-killing drugs where they are needed. It also slows the absorption of chemotherapy agents, allowing more exposure to the drugs, according to researchers.
Devansu Tewari, MD, director of the gynecologic oncology division at Southern California Permanente Medical Group and assistant professor of obstetrics and gynecology at the UC Irvine School of Medicine, and colleagues reviewed data from two Gynecologic Oncology Group trials that included a combined 876 patients to determine the long-term survival of patients with advanced ovarian cancer who underwent intraperitoneal therapy.
The investigators used Cox proportional hazards regression models to perform statistical analyses.
After median follow-up of more than 10 years, median survival was greater among patients who underwent intraperitoneal therapy compared with IV therapy (61.8 months vs. 51.4 months; P=.048). The findings translate to a 17% reduction in risk for death (adjusted HR=0.84; 95% CI, 0.71-0.97), the researchers wrote.
“Too many women do not receive an explanation about the advantages and disadvantages of [intraperitoneal] therapy and that it could be a potential life saver,” Tewari said in a press release. “But there is also a caution that it should be administered by a physician who has expertise in the treatment and can best manage the risks and side effects.”
Researchers identified several prognostic factors associated with improved survival after intraperitoneal therapy. They included younger age (AHR=1.01; 95% CI, 1.01-1.02); better performance status (AHR=0.75; 95% CI, 0.56-0.99); low-grade histology (AHR=0.75; 95% CI, 0.56-0.99); microscopic residual disease (AHR=0.53; 95% CI, 0.45-0.63); and non-clear cell/mucinous histology (ARH=0.36; 95% CI, 0.26-0.49).
Researchers determined the survival advantage of intraperitoneal therapy was evident among patients with gross residual disease (44% vs. 35%) and microscopic residual disease (65% vs. 58%).
Five-year OS was 59% among all patients who completed five or six cycles of intraperitoneal chemotherapy, 33% among patients who completed three or four cycles, and 18% among those who completed one or two cycles (P<.001).
Younger, healthier patients were more likely to be able to complete the suggested six cycles of therapy, the researchers said. Adverse effects reported by patients who have undergone intraperitoneal therapy include abdominal pain and numbness in the hands and feet.
“There is no question [intraperitoneal] therapy should be much more widely offered,” Tewari said. “Advanced ovarian cancer patients should consult with gynecologic oncologists or medical oncologists with experience in this cancer who have the expertise to determine the best therapy. At the very least, these women should be treated by someone who has experience with [intraperitoneal] therapy issues and knowledge of whether she would be a good candidate.”
For more information:
Tewari D. Abstract #6. Presented at: Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer; March 9-12, 2013; Los Angeles.
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Many of us in the field were very excited to see these data. This is some of the first long-term follow-up we have seen that really makes an impact on survival for patients with ovarian cancer. This is what we had been hoping for, but it’s rare that we actually see something this compelling. This is a real practice changer for many people.
The most important take-home message is the improvement in OS. We have believed for several years that this type of chemotherapy may be beneficial. Now the long-term follow-up shows it is beneficial, and this is something our patients have access to. This is not some idealistic, unfeasible idea. It’s actually something we do in practice. We just need to use it more widely and consider it for more patients. When we do that, I suspect our patients will have better outcomes overall.
There are a couple issues to keep in mind. First, there is more toxicity than the standard IV chemotherapy, at least in some patients, and that is something we need to consider on an individual basis. Also, this is something that is probably best performed in a center that is familiar with doing intraperitoneal therapy because there is a skill set that goes along with administering chemotherapy this way.
These findings have started quite a buzz in the oncology community because they really matter for patients. So many times we look at things that happen in little increments and maybe don’t translate into actual benefits in patient outcomes, but this really does. It matters long term, and that’s very exciting.