Patients with advanced ovarian cancer who undergo intensive treatment with chemotherapy that bathes the abdomen are significantly more likely to live longer than those who receive standard intravenous (IV) chemotherapy, according to a study that analyzed long-term follow-up from two landmark Gynecologic Oncology Group (GOG) trials comprising 876 patients. Results of the study were presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer, held in Los Angeles in March.
Women who receive the treatment in the form of intraperitoneal, or IP, chemotherapy are 17% more likely to survive longer than those who have IV chemotherapy, according to the analysis, which had a median follow-up of more than 10 years. Median survival was more than 5 years (62 months) for patients in the IP group and about 4 years (51 months) for patients in the IV group.
The findings also suggest women who complete most or all of the recommended six cycles of IP therapy are likely to live longer than women who complete four or fewer cycles. After 5 years, 59% of patients who completed five or six cycles of IP therapy were alive, compared to 33% of those who completed three or four cycles and 18% of those who completed one or two cycles. Patients who are unable to receive the full six cycles of IP therapy typically transition to IV chemotherapy for the remaining cycles.
‘A Potential Lifesaver’
“Too many women do not receive an explanation about the advantages and disadvantages of IP therapy and that it could be a potential lifesaver,” said Devansu Tewari, MD, Director of Gynecologic Oncology for the Southern California Permanente Medical Group in Orange County, California, of Kaiser Permanente and Assistant Professor of Obstetrics and Gynecology at the University of California, Irvine School of Medicine. “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.”
Every year, more than 22,000 women are diagnosed with ovarian cancer and more than 15,000 die of the disease. In standard IV chemotherapy, the drugs are infused into the bloodstream and throughout the body, whereas IP treatment directs the chemotherapy to the abdomen. This not only places a high concentration of cancer-killing drugs where they are needed, but the chemotherapy agents are absorbed more slowly, providing more exposure to the medicine. Intraperitoneal is recommended by the National Cancer Institute for women who have had optimal surgery.
Because IP therapy is more rigorous, some of the side effects are also more intense, such as numbness in the hands and feet and abdominal pain, and some women are unable to complete the suggested six cycles of therapy. Researchers found younger, healthier patients were more likely to complete more cycles of IP.
“There is no question IP therapy should be much more widely offered, and 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,” said Dr. Tewari. “At the very least, these women should be treated by someone who has experience with IP therapy issues and knowledge of whether she would be a good candidate.” ■