Updates in Ovarian and Cervical Cancers - Episode 10

Intraperitoneal Chemotherapy in Ovarian Cancer

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Long-term findings from two randomized trials demonstrated that intraperitoneal (IP) chemotherapy significantly improved survival compared with intravenous (IV) therapy. The combined analysis of the GOG-172 and GOG-114 trials showed that patients treated with IP chemotherapy experienced a 16% reduction in the risk of progression compared with IV therapy. Additionally, IP chemotherapy led to a median overall survival (OS) of 62 months compared with 51 months for IV therapy.

Clinical studies have suggested that women with BRCA1 or BRCA2 mutation positive ovarian cancer may experience an even more significant benefit with IP chemotherapy, says Warner K. Huh, MD. In the GOG-172 trial approximately 48% of patients harbored a BRCA1 mutation. In this subgroup, the median OS was 84 months with IP chemotherapy versus 47 months with the IV treatment. In patients with normal BRCA1 expression, the median OS was 58 months with the IP treatment compared with 50 months in the IV group.

In GOG-172, the IV arm received standard paclitaxel plus cisplatin while the IP arm received IV paclitaxel followed by IP cisplatin plus paclitaxel. This fractionating of paclitaxel may have contributed to the survival advantage, suggests Robert A. Burger, MD.

Approximately 20% to 25% of his patients who are optimally cytoreduced receive IP therapy, explains Michael J. Birrer, MD. This approach is not more widely utilized due to an increased incidence of adverse events. In general, IP chemotherapy is associated with a greater incidence of abdominal pain, nausea, and vomiting compared with IV treatment.