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Intraperitoneal Chemotherapy Improves Survival in Ovarian Cancer

Intraperitoneal chemotherapy improved long-term survival compared with standard intravenous chemotherapy for advanced ovarian cancer. These results were recently presented at the 2013 annual meeting of the Society of Gynecologic Oncology.

Ovarian cancer remains a difficult cancer to treat, particularly once the cancer has spread from its site of origin. Researchers have been evaluating delivery of chemotherapy into the peritoneum (intraperitoneal) compared to delivery of chemotherapy into the veins (intravenous) for the treatment of ovarian cancer.

The peritoneum is a membrane that lines the abdominal and pelvic area. The concept behind intraperitoneal (IP) chemotherapy is that it is in the area of the cancer, so cancer cells receive chemotherapy more directly while the rest of the body can be spared from some severe side effects of treatment.

Results from important clinical trials have demonstrated an improvement in outcomes for IP chemotherapy versus intravenous (IV) in ovarian cancer; however, for various reasons, the clinical practice of IP administration never became widespread.

Researchers from the University of California recently reviewed data from 2 large clinical trials comparing IP to IV chemotherapy for ovarian cancer patients. Their review was an attempt to further elucidate the benefits of IP administration; particularly those who might receive the most benefit, the optimal number of administration cycles, and long-term effects of IP therapy.

The reviewers included data from the GOG 172 and GOG 114 clinical trials, which included 876 patients with stage III ovarian or peritoneal cancers. Prior to receiving chemotherapy, patients underwent surgery.

Both trials demonstrated a 5.5 to 6-month improvement in survival without cancer progression for those treated with IP chemotherapy, compared to those treated with IV chemotherapy.
In the GOG 114 trial, IP chemotherapy was associated with an improvement in survival of 11 months, while in the GOG 172 trial, IP chemotherapy improved survival by 16 months over IV chemotherapy.
Importantly, survival at 5years was significantly increased with increased number of chemotherapy cycles given. Survival was 18% for those who completed 1-2 cycles, 33% for those who completed 3-4 cycles and 59% for those who completed 5-6 cycles of chemotherapy.
The researchers stated that ongoing trials are evaluating different chemotherapy regimens and targeted therapies for women with ovarian cancer with the hopes of continually improving their survival.

Reference: Tewari D, et al. Long-term survival advantage of intraperitoneal chemotherapy treatment in advanced ovarian cancer. Proceedings from the 2013 annual meeting of the Society of Gynecologic Oncology. Abstract 6.