Abdominal chemotherapy improves ovarian cancer survival

(This article was first printed in the March 2006 issue of the Harvard Women's Health Watch. For more information or to order, please go to www.health.harvard.edu/womens.)

A treatment that pumps anticancer drugs directly into the abdomen — called intraperitoneal (IP) therapy — stands poised to change medical treatment for women with advanced ovarian cancer. Each year, 25,000 women are diagnosed with ovarian cancer, mostly at an advanced stage.

Based on the results of eight trials in the past two decades comparing intravenous (by vein) chemotherapy with a combination of intravenous and IP therapies, the National Cancer Institute issued an alert in January 2006 encouraging clinicians to use IP therapy after surgery for ovarian cancer.

The announcement coincided with the publication of a study in the Jan. 5, 2006, New England Journal of Medicine, reporting that women with newly diagnosed ovarian cancer who received chemotherapy drugs directly into the abdomen (see graphic) lived 16 months longer than women who got standard intravenous chemotherapy — the longest increase in survival time reported in any randomized trial for ovarian cancer.

The study, conducted by researchers with the Gynecologic Oncology Group, included 415 women with ovarian cancer that had spread beyond the ovary to the abdominal (peritoneal) cavity. All had undergone surgery to remove the cancer. The women were assigned at random to receive paclitaxel (Taxol) by vein followed by either intravenous cisplatin (Platinol) or intraperitoneal cisplatin at a higher dose plus intraperitoneal paclitaxel a few days later. Both groups received six treatments, one every three weeks.

Although the women who received part of their chemotherapy by abdomen survived longer, many found the treatment extremely difficult. IP therapy improves outcomes in part because higher doses of the drugs can be used. But side effects include severe fatigue, pain, infections, and gastrointestinal and neurological problems. Catheter-related complications were also a problem. Nearly 6 in 10 of the women in the IP group switched partway through the trial to standard intravenous chemotherapy. Yet those women survived longer than the intravenous-only group. This suggests that even some IP therapy is better than none at all — and that greater benefits may be likely if it can be made more tolerable. In the meantime, the National Cancer Institute is advising physicians to discuss IP therapy with newly diagnosed women who are candidates for the treatment and to refer patients to centers that offer it if their own institutions do not.

More information about IP therapy and the medical centers that offer it is available at ctep.cancer.gov/highlights/ovarian.html, or call the National Cancer Institute at 800-422-6237.

(This article was first printed in the March 2006 issue of the Harvard Women's Health Watch. For more information or to order, please go to www.health.harvard.edu/womens.)

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