What is Intraperitoneal Chemotherapy for Ovarian Cancer?

What is intraperitoneal chemo for ovarian cancer?
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Intraperitoneal chemotherapy is a way of administering chemotherapy for ovarian cancer directly into the abdominal cavity. While most chemotherapy is intravenous, and many new biologic or targeted therapies are oral, the intraperitoneal method of delivering chemotherapy is one of the recommended first-line treatments for women with stage III ovarian cancer.

A Pivotal Study

In 2006, the results of the Gynecologic Oncology Group clinical trial GOG 172 were published in the New England Journal of Medicine.

In this study, women were eligible for treatment if they had stage III ovarian cancer or primary peritoneal cancer and if they had an optimum cytoreductive surgery (meaning that no residual tumor mass more than 1 cm was left behind after surgery).

The trial was randomized, which means that patients were assigned to a treatment group by a computerized flip of a coin. Of these 415 women in the study, half received traditional intravenous chemotherapy with cisplatin and paclitaxel (Taxol). The other half received the same drugs, but in a combination of intravenous (paclitaxel) and intraperitoneal (cisplatin and paclitaxel) delivery.

This is not an easy therapy to take, and the study results confirmed that. Only 42% of the women in the intraperitoneal group were able to receive all six cycles of intraperitoneal chemotherapy. 90% of women in the intravenous group received all six cycles. The women who received intraperitoneal chemotherapy had more severe or life-threatening fatigue, pain, low blood counts, and neurologic side effects.

Also important to note is that nine women died during chemotherapy – four in the intravenous group and five in the intraperitoneal group. The deaths were due to infection.

A Survival Benefit

This 2006 study made headlines, despite the toxicity of treatment, because of the survival results. Despite the fact that only 42% of women in the intraperitoneal group were able to receive all six cycles of therapy, the progression-free survival (the survival time before cancer progresses) was 5 ½ months longer for the intraperitoneal chemotherapy group.

Even more impressive was the overall survival data. Women who received intraperitoneal chemotherapy had an overall survival that was almost 16 months longer than women who received intravenous chemotherapy alone – 65.6 months compared to 49.7 months.

Based heavily on the results of this study, as well as on two other phase III trials, the National Cancer Institute issued a rare Clinical Announcement recommending that the use of intraperitoneal chemotherapy should be strongly considered for eligible patients.

Practical Considerations

Receiving intraperitoneal chemotherapy is not for everyone with ovarian cancer, however. Remember, based on the pivotal study, we only know that it benefits women who have stage III disease who have also had an optimum cytoreductive surgery (no residual tumor mass more than 1 cm was left behind after surgery).

In order to have intraperitoneal chemotherapy, an intraperitoneal catheter (port) must be placed in the abdominal wall by the gynecologic oncologist. If not placed at the time of initial surgery, it may be placed later, in a separate surgical procedure by the gynecologic oncologist or by an interventional radiologist.

The Nurses who administer chemotherapy through this port must be skilled and comfortable with the approach. The catheter may leak or become obstructed. Management of the side effects requires a skilled medical oncologist or gynecologic oncologist who has experience in this type of treatment.

The Follow Up

A recent study by Dr. Wright and colleagues, published in the Journal of Clinical Oncology, showed that not all women who are eligible for intraperitoneal chemotherapy are receiving it. Her team studied a total of 823 women who had stage III ovarian or fallopian tube or primary peritoneal carcinoma. These women were treated at six different large cancer centers that are part of the National Comprehensive Cancer Network, including City of Hope, Dana-Farber/Brigham and Women's, Fox Chase, Ohio State University, The University of Texas MD Anderson Cancer Center, and the University of Michigan. 

Dr. Wright’s group found that less than 50% of women who were eligible to receive intraperitoneal chemotherapy actually received it. Their study also confirmed that women who received intraperitoneal chemotherapy lived longer than those who received only intravenous chemotherapy.

The Take-Home Message

Intraperitoneal chemotherapy for ovarian cancer or primary peritoneal cancer is an important tool in the treatment of these diseases, with improved survival rates for patients who can receive this therapy. However, it can be a difficult treatment with worse side effects than traditional intravenous chemotherapy. If you are newly diagnosed with advanced stage ovarian cancer or primary peritoneal cancer, it is worth having a discussion with your oncologist about whether this approach is right for you.

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