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Intraperitoneal chemotherapy prolongs OS in advanced ovarian cancer
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Intraperitoneal chemotherapy was associated with long-term survival benefits compared with IV chemotherapy in patients with advanced ovarian cancer, according to retrospective study results.
The benefits of intraperitoneal chemotherapy — which increased with each cycle of chemotherapy — also persisted in patients with gross residual disease, results showed.
“Epithelial ovarian carcinoma is the leading cause of gynecologic cancer mortality in the United States,” John K. Chan, MD, of the division of gynecologic oncology at the Palo Alto Medical Foundation, and colleagues wrote. “The peritoneum serves as the primary site of spread and failure in most cases of advanced cancers. Thus, this region provides a sanctuary site for developing local therapies.”
Although trials have demonstrated a survival benefit with intraperitoneal vs. IV therapy in advanced, low-volume ovarian cancer, intraperitoneal chemotherapy is not used widely in the United States, according to study background.
Chan and colleagues sought to determine whether more cycles of intraperitoneal chemotherapy were associated with improved outcomes and whether these benefits persisted for an extended period.
The analysis included 876 patients (median age, 48.6 years) with advanced-stage ovarian cancer who were enrolled on the Gynecologic Oncology Group (GOG) protocols 114 or 172. Most of the women (90.2%) were white.
Researchers had assigned patients IV chemotherapy (n = 436) or intraperitoneal chemotherapy (n = 440).
Median follow-up was 10.7 years.
Medial OS with intraperitoneal chemotherapy was 61.8 months, whereas median OS in the IV arm was 51.4 months (P = .042). Adjusted analyses indicated intraperitoneal chemotherapy was associated with a 23% reduction in the risk for death (adjusted HR [aHR] = 0.77; 95% CI, 0.65-0.9).
Further, the risk for death decreased 12% for each completed cycle of intraperitoneal chemotherapy (aHR = 0.88; 95% CI, 0.83-0.94).
Median PFS was 25 months in the intraperitoneal arm and 20 months in the IV arm (P = .019). Intraperitoneal therapy was associated with a 21% decreased risk for progression (aHR = 0.79; 95% CI, 0.67-0.92).
Intraperitoneal therapy improved OS outcomes among patients with gross residual disease up to 1 cm (aHR = 0.75; 95% CI, 0.62-0.92); however, the researchers noted that these patients still faced an increased mortality rate compared with patients with no visible disease (aHR = 1.89; 95% CI, 1.48-2.43).
Poorer survival also was significantly associated with clear/mucinous vs. serous histology (aHR = 2.79; 95% CI, 1.83-4.24).
Younger patients were more likely to complete the intraperitoneal regimen. The odds of completing intraperitoneal therapy decreased 5% for each year of age (OR = 0.95; 95% CI, 0.93-0.96).
“The long-term survival benefits described in this report may encourage more clinicians to adopt [intraperitoneal] therapy in the community,” Chan and colleagues concluded. “[Intraperitoneal] therapy may be implemented as a quality measure at institutions with the expertise and support teams necessary to administer [intraperitoneal] treatment. Clinicians should support patients through the [intraperitoneal] regimen, particularly if there are no significant or excessive toxicities.”
Although intraperitoneal therapy demonstrated improved outcomes with more than 10 years of follow-up, questions still remain about its overall effectiveness, Michael A. Bookman, MD, of U.S. Oncology Research and Arizona Oncology, and Mark F. Brady, PhD, of the NRG Oncology Statistical and Data Center, wrote in an accompanying editorial.
“Even in these favorable-risk populations, the actuarial curves demonstrate a continued reduction in OS at late time points, with a trend toward confluence at 10 years, without any evidence of cure and without a reduction in disease-related mortality,” Bookman and Brady wrote. “Clearly, although [intraperitoneal] therapy offers meaningful benefit, new approaches are needed for patients with advanced-stage disease.” – by Cameron Kelsall
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