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Intraperitoneal Chemotherapy for Ovarian Cancer Prolongs Survival

The survival benefit seen in this study is one of the largest ever observed for a new therapy in gynecologic oncology.

Standard therapy for ovarian cancer involves surgical "debulking" of the tumor, followed by intravenous therapy with a platinum analogue and paclitaxel. To determine whether postsurgical intraperitoneal chemotherapy offers greater advantage, the NIH-sponsored Gynecologic Oncology Group conducted a trial among 415 patients with stage III epithelial ovarian or peritoneal carcinoma and no residual mass greater than 1 cm in diameter after surgery.

Patients were randomized to receive intravenous paclitaxel plus intravenous cisplatin or intravenous paclitaxel plus intraperitoneal cisplatin. Treatments were administered every 3 weeks for six cycles. Patients with complications in the intraperitoneal group received intravenous therapy for the remaining cycles, and those with toxicity to cisplatin in either group had intravenous carboplatin substituted.

A full 83% of patients in the intravenous group — but only 42% in the intraperitoneal group — completed all six cycles of their assigned therapy. Despite this difference, the intraperitoneal group still had a significantly longer median duration of progression-free survival (23.8 vs. 18.3 months) and overall survival (65.6 vs. 49.7 months) than did the intravenous group. Three to 6 weeks after therapy, quality of life was significantly worse in the intraperitoneal versus the intravenous group, but this difference disappeared within a year.

Comment: An editorialist notes that this is one of the largest survival benefits ever observed for a new therapy in gynecologic oncology. Further randomized trials should be aimed at refining such therapy to reduce toxicity.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine January 13, 2006

Citation(s):

Armstrong DK et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006 Jan 5; 354:34-43.

• Original article (Subscription may be required)
• Medline abstract (Free)

Cannistra SA. Intraperitoneal chemotherapy comes of age. N Engl J Med 2006 Jan 5; 354:77-9.

• Original article (Subscription may be required)
• Medline abstract (Free)