Monday, August 10, 2015
posted by siteadmin @ 09:08 PM

Intraperitoneal chemotherapy underused for ovarian cancer, report suggests

Reuters Health, Article by Will Boggs, MD

NEW YORK chemotherapy improves survival in women with ovarian cancer, but fewer than 50% of eligible patients receive it, according to data from six comprehensive cancer centers.

“Women with optimally resected stage III ovarian cancer live longer when they are treated with IP/IV chemotherapy, compared with IV chemotherapy, and we should try to increase its use, because it’s one of the best treatments we have,” Dr. Alexi A. Wright from Dana-Farber/Brigham and Women’s Cancer Center in Boston told Reuters Health by email.

After favorable results from the Gynecologic Oncology Group GOG-172 trial that demonstrated a 16-month improvement in overall survival for IP/IV chemotherapy, the National Cancer Institute issued a clinical announcement in 2006 encouraging its use in women with stage III ovarian cancer.

Dr. Wright and colleagues examined the use of IP/IV chemotherapy over time and also looked at outcomes in a prospective study of 823 women with stage III, optimally cytoreduced ovarian cancer.

Their findings appeared online August 3 in the Journal of Clinical Oncology.

The use of IP/IV chemotherapy increased from 0% to 33% annually from 2003 to 2006, increased to nearly 50% from 2007 to 2008, and remained at that level thereafter. Only 29% of the women received the GOG-172 regimen, and 43% received modified regimens. The rest (28%) were enrolled into clinical trials.

Factors associated with the use of IP/IV chemotherapy included younger age and fewer comorbidities, but there were no differences in IP/IV chemotherapy use by race/ethnicity, substage, or extent of residual disease.

Apart from anemia and hospitalization rates, which were higher for IP/IV chemotherapy than for IV chemotherapy alone, clinical complications did not differ by route of chemotherapy administration, the researchers found.

The odds of presenting with distant disease at first recurrence were significantly higher after IP/IV chemotherapy (58.8%) than after IV chemotherapy (29.4%).

In a propensity-matched analysis, 3-year overall survival was significantly better after IP/IV chemotherapy (81%) than after IV chemotherapy alone (71%).

“We are hopeful that these results will convince oncologists that it’s possible to give IP/IV chemotherapy safely, and more will do it,” Dr. Wright said. “Data are very persuasive, particularly given we found many fewer toxicities. But patients should also be able to find out whether their doctors offer IP/IV chemotherapy, and how often. Given the survival advantage we found, IP/IV chemotherapy could be a potential quality measure that’s reported.”

“Our study did not examine why IP/IV chemotherapy is underused outside of clinical trials so I cannot say for sure,” Dr. Wright said. “Many patients stopped IP/IV chemotherapy because it was too toxic in the earlier clinical trial. We found that physicians at academic centers modified the chemotherapies given to minimize toxicities – lowering the dose or changing chemotherapies so to minimize side effects – so this suggests that many physicians may have been afraid of harming patients with the side effects.”

“Strikingly, however, even with these modifications, women who received IP/IV chemotherapy lived longer than those who were treated with IV chemotherapy, and our results were almost identical to the clinical trial except that we found fewer toxicities (maybe because physicians had lowered the dose),” Dr. Wright said.

Dr. Alberto Mendivil from Nancy Yeary Women’s Cancer Research Foundation in Newport Beach, California, told Reuters Health by email, “In our practice, every eligible patient is offered IV/IP chemo. There are some patients that may not tolerate IP chemo due to risk of drug toxicity, poor patient performance status, intraoperative/surgical events preventing placement of IP catheter, patient refusal of IP chemo, or patient may not be treated by gynecologic oncologist and therefore may not have access to a physician who feels comfortable administering IP chemotherapy.”
“Whenever possible, patients with gyn malignancies should be treated by experts in gyn malignancies,” said Dr. Mendivil, who was not involved in the new analysis. “The Society of Gynecologic Oncology and the National Comprehensive Cancer Network have guidelines for the treatment of gynecologic cancers. Educating the medical community on the benefits of any optimal therapeutic modality will lead to greater adoption of that treatment modality.”


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