Intraperitoneal Chemotherapy for Ovarian Carcinoma
May 1, 2002
Intraperitoneal Chemotherapy for Ovarian Carcinoma
Abstract & Commentary
Synopsis: Although prolonged survival was observed in selected patients receiving IP platinum-based therapy, it is not possible to determine the contribution of IP therapy to survival in this study.
Source: Barakat RR, et al. J Clin Oncol. 2002;20: 694-698.
Barakat and colleagues from memorial sloan-Kettering Cancer Center reviewed the records of 433 patients who received intraperitoneal (IP) therapy for ovarian cancer between 1984 and 1998; follow-up data were available for 411 patients. IP therapy was provided as consolidation therapy (n = 89), or for treatment of persistent (n = 310) or recurrent (n = 12) disease after surgery and initial systemic therapy; therapy usually consisted of platinum-based combination therapy. The mean age of patients was 52 years (range, 25-76 years). Distribution by stage and grade was as follows: stage I, 7; II, 24; III, 342; IV, 52; not available (NA), 8; and grade 1, 30; 2, 99; and 3, 289; NA, 15. The median survival from initiation of IP therapy by residual disease was none, 8.7 years; microscopic, 4.8 years; less than 1 cm, 3.3 years; more than 1 cm, 1.2 years. In a multivariate analysis, the only significant predictors of long-term survival were grade and size of residual disease at initiation of IP therapy. Barakat et al concluded that, although prolonged survival was observed in selected patients receiving IP platinum-based therapy, it is not possible to determine the contribution of IP therapy to survival in this study. A relationship between size of disease at the initiation of IP therapy and long-term survival was demonstrated.
Comment by David M. Gershenson, MD
Ovarian cancer remains a challenging disease. Despite a high response rate to postoperative chemotherapy after primary cytoreductive surgery—on the order of 80%—most patients with advanced-stage disease will ultimately relapse. Therefore, several strategies have been studied as consolidation therapy for patients in remission and for patients with persistent disease after primary therapy—further systemic chemotherapy, radiation, intraperitoneal chemotherapy (as in this study), and high-dose chemotherapy with stem cell support. The group from Memorial Sloan-Kettering has focused much of their efforts on IP chemotherapy. Several other groups have also studied IP therapy over the past 2 decades or so, and it has found its way into clinical practice in some sectors without any clear information suggesting benefit. Unfortunately, as Barakat et al themselves acknowledge, it is difficult if not impossible to interpret the true value of this approach without conducting a randomized trial. Distinguishing the biologic behavior of the tumor from the influence of the intervention is the challenge in studies such as this. IP therapy has been tested in 3 major randomized trials as part of primary treatment, and the data thus far suggest a slight but real benefit in terms of progression-free survival or overall survival for IP therapy compared with intravenous therapy. Nevertheless, this approach has not been widely embraced, most likely related to the technical difficulties and skepticism regarding the true benefits.
Dr. Gershenson is Professor and Chairman, Department of Gynecology, M.D. Anderson Cancer Center, Houston, Tex.
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