Abdominal Chemotherapy for Ovarian Cancer Improves Survival
Women who received chemotherapy directly in their abdomens as part of treatment for advanced ovarian cancer lived more than a year longer than women who received the same chemotherapy intravenously, researchers reported last week.
The findings confirm and expand recent research showing that intraperitoneal (IP) chemotherapy, which delivers drugs directly to the abdominal cavity through a catheter, can significantly increase survival for some women with the disease.
In the study, women who received chemotherapy intravenously and through an IP route lived on average 16 months longer than women who had IV chemotherapy only, according to findings in the January 5 New England Journal of Medicine (NEJM).
Even women who completed only one or two of the planned six cycles of IP therapy benefited.
"The results of this and two prior studies demonstrate that IP chemotherapy should be used to treat many women with this disease," says Dr. Deborah Armstrong of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, who led the trial.
The study included about 400 women. Half received cisplatin and paclitaxel intravenously; the others received paclitaxel intravenously plus cisplatin and paclitaxel via an IP route.
An NEJM editorial notes that such a large survival benefit is rarely seen in cancer clinical trials and should help change how the disease is treated.
As the results were made public, NCI issued a rare clinical announcement to raise awareness about IP chemotherapy for ovarian cancer among physicians and patients. Currently, only about 1 percent of ovarian cancer patients are treated with IP chemotherapy.
"We think the weight of the evidence now supports the use of this treatment for some women with ovarian cancer," says Dr. Edward Trimble, who heads the surgery section of NCI's Cancer Therapy Evaluation Program.
The new study is the eighth randomized clinical trial evaluating IP chemotherapy for selected women and the third sponsored by NCI. The NCI trials included only women who had undergone successful surgery to remove the bulk of their tumors.
"Our take-home message is that women need to have excellent surgery from day one and should be seen by a surgeon who specializes in gynecological cancers," says Dr. Armstrong, who is not herself a surgeon.
Ovarian cancer causes the most deaths of any gynecological cancer in the United States and frequently goes undetected until tumors spread beyond the ovaries.
The NCI announcement - the first since 1999 - was warranted, says Dr. Trimble, because IP chemotherapy is widely regarded as an old technology and previous trials have generated little interest among physicians.
IP chemotherapy is not used regularly in part because of increased toxicity associated with the delivery method. But the new study suggests that while some patients experience complications, most problems are manageable and transient. One year after treatment, both groups reported a similar quality of life.
The IP method is "slightly harder" on some patients than conventional chemotherapy, says Dr. Trimble, but he adds: "We're trying to get the message out that we need to accept some short-term toxicity in exchange for the major increase in survival."
By Edward R. Winstead