Intraperitoneal Chemotherapy for Advanced Ovarian Cancer

Virginia Kaklamani, MD, DSc reviewing Wright AA et al. J Clin Oncol 2015 Aug 3.

Adding IP chemotherapy to intravenous chemotherapy improves survival, but even in academic cancer centers, this approach is used in fewer than half of patients.

A 2006 study showed that adding intraperitoneal (IP) chemotherapy to intravenous (IV) chemotherapy following surgery significantly improves survival in women with stage III ovarian cancer (N Engl J Med 2006; 354:34), prompting the National Cancer Institute to urge the adoption of this approach. However, given barriers to the acceptance of combination IP/ IV chemotherapy — such as perceived toxicities, the potential for inpatient administration, and the lack of a standard regimen — how widely it has since been used in clinical practice is unclear.

Now, investigators have conducted a prospective cohort study to evaluate the use and effectiveness of IP/IV chemotherapy versus IV chemotherapy alone in 498 patients with optimally resected stage III ovarian cancer diagnosed at six academic cancer centers between 2006 and 2012.

Results were as follows:

• Fewer patients received IP/IV chemotherapy than IV chemotherapy alone (41% vs. 59%).
• No between-group differences were observed in terms of race, ethnicity, or stage or extent of residual disease, although patients who received IP/IV versus IV chemotherapy alone were younger and had fewer comorbidities.
• The only toxicity that was increased with IP/IV versus IV chemotherapy alone was anemia.
• Chemotherapy completion rates were similar in both groups.
• Risk for distant disease at first recurrence was higher with IP/IV chemotherapy (59% vs. 29%).
• Three-year overall survival rates were significantly higher with IP/IV chemotherapy (81% vs. 71%).

Citation(s):

Wright AA et al. Use and effectiveness of intraperitoneal chemotherapy for treatment of ovarian cancer. J Clin Oncol 2015 Aug 3; [e-pub].