ESMO E-Learning: Ovarian Cancer IP Chemotherapy

Learning Objectives

  1. To provide an update on the rationale for intraperitoneal chemotherapy in ovarian cancer 
  2. To provide a summary of the evidence and interpretation of data from the clinical trials with intraperitoneal chemotherapy for ovarian cancer
  3. To provide key information relevant for the current place of intraperitoneal chemotherapy in the management of ovarian cancer 
Title Duration Content CME Points CME Test
Ovarian Cancer IP Chemotherapy 42 min. 41 slides 1 Take Test
conte-pierfranco
Pierfranco Conte
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In this E-Learning module, the author provides a rationale for intraperitoneal chemotherapy and summarises key data of its efficacy and toxicity from the pivotal trials in ovarian cancer. The Module elaborates new data from old trials, features results from new trials and the questions addressed, and provides evidence of the place of intraperitoneal chemotherapy in the current management of patients with ovarian cancer. Furthermore, the author digs into hyperthermic intraperitoneal chemotherapy (HIPEC). 

In the introduction of the module, state of the art facts, relevant to the management of patients with ovarian cancer, are provided: tissue should be obtained for histopathologic diagnosis; staging should be performed according to FIGO guidelines, including lymph node sampling and peritoneal staging. In early stages, adjuvant chemotherapy reduces the risk of relapse by one third; in advanced stages, optimal surgical debulking is the most important determinant of survival. Neoadjuvant treatment followed by debulking surgery is an acceptable option for patients unlikely to be optimally resected upfront. In advanced stages, chemotherapy can induce an overall response in 70-80% of the patients with 20-50% of patients reaching 5-year survival. Carboplatin/paclitaxel is the standard chemotherapy regimen with recent introduction of bevacizumab for high risk patients; maintenance treatment with PARP inhibitor prolongs progression-free survival in case of BRCA mutated high grade serous ovarian cancer.

In ovarian cancer, the major route of tumour spread is intraperitoneal and intraperitoneal chemotherapy administration delivers the most concentrated dose of anticancer drugs to the cancer cells in the peritoneal cavity. When given intraperitoneally, chemotherapy  also gets absorbed into the circulation. The side effects of intraperitoneal chemotherapy are often more severe than with intravenous chemotherapy.

When ovarian cancer is elaborated in teaching materials, the role of and evidence for intraperitoneal chemotherapy are usually not included, although it is part of practice in some clinics. Therefore, a systemic coverage of the available evidence was needed and in this module the author elaborates intraperitoneal chemotherapy for ovarian cancer from different angles. HIPEC, however, is a different story and the author concludes that HIPEC cannot be considered as standard treatment and should not be offered to patients with ovarian cancer outside of prospective clinical trials. 

Last update: 13 March 2017

The author has reported no conflict of interest