Almost 10 years following a study that proved intraperitoneal (IP), or abdominal, chemotherapy, along with intravenous (IV) therapy, may add 16 months or more to the lives of women with ovarian cancer, less than half of these patients at US hospitals receive this type of treatment
Alexi A. Wright, MD, MPH
Almost 10 years following a study that proved intraperitoneal (IP), or abdominal, chemotherapy, along with intravenous (IV) therapy, may add 16 months or more to the lives of women with ovarian cancer, less than half of these patients at US hospitals receive this type of treatment, according to aNew York Timesarticle.1
In a study2published August 3, 2015, in theJournal of Clinical Oncology, medical oncologists looked at IP and IV chemotherapy in 823 women with stage III ovarian cancer at six National Comprehensive Cancer Network (NCCN) institutions, between the years of 2003 and 2012.
Study findings showed that the use of IP/IV chemotherapy increased from 0% to 33% between 2003 and 2006, and then to 50% between the years of 2007 and 2008. In the years following, the results seemed to plateau. From 2006 to 2012, the adoption of IP/IV chemotherapy varied by institution from 4% to 67% (P<.001), and 43% of the patients were given modified IP/IV regimens at the initiation of treatment.2
IP/IV chemotherapy has been associated with considerably improved overall survival (3-year OS, 81% vs 71%; HR, 0.68; 95% Cl, 0.47-0.99) compared with IV chemotherapy alone. Despite its significant increase at NCCN centers between 2003 and 2012, less than 50% of eligible patients with ovarian cancer received it.2
“The procedure is not used very much, even though it has shown to improve survival,” said Maurie Markman, MD, national director of Cancer Treatment Centers of America, in an interview withTargeted Oncology. In theNew York Timesarticle, he expressed his concern by describing the underuse of IP/IV chemotherapy as tragic and unfortunate.1
The treatment may be unused because some doctors may still have their doubts regarding its benefits and possible toxicity threat.1“I can’t speak for them, but it takes more time, more effort, they don’t get paid for that time and effort, and the strategy overall has more adverse effects than giving the drug intravenously,” said Markman. Some of those adverse effects include infection and pain.
IP/IV chemotherapy does not involve any new drugs or devices, so there is no urgency in educating gynecologic oncologists about it, according to Markman.1
Alexi A. Wright, MD, MPH, assistant professor of medicine at Harvard Medical School and the lead author on the study, describes how she and her team suspected low integration of IP chemotherapy, even at the best centers, but they were surprised to see a large variation between cancer centers. She explains how the study was the first to look at outcomes from IP treatment administered as part of regular medical practice and not part of a clinical trial.1
Women do not need to enroll in a clinical trial to obtain the benefit of IP treatment. Despite the growing concern of IP treatment toxicities, this new study produced less severe adverse effects. Eighty-nine percent of women who received IP treatment finished the planned course, compared with 91% of women who chose only the IV method.1
Markman concluded by urging patients with ovarian cancer and who have undergone surgery to speak with their gynecologic oncologist and see if IP therapy is right for them. If the oncologist is not interested in administering this treatment, or he or she does not feel capable of doing it, then Markman would refer the patients who want IP treatment to a gynecologic oncologist who is knowledgeable in this treatment strategy.
1. Grady, Denise. New York Times. Effective ovarian cancer treatment is underused, study finds.http://www.nytimes.com/2015/08/04/health/ovarian-cancer-abdominal-chemotherapy-underused.html?partner=rss&emc=rss&_r=4. Accessed August 6, 2015.
2. Wright, AA. Cronin, A. Milne, DE et al. Use and effectiveness of intraperitoneal chemotherapy for treatment of ovarian cancer.J Clin Oncol. 2015;33(22). doi:10.1200/JCO.2015.61.4776.