Long-term IP Chemotherapy Benefit Found For Advanced Ovarian Cancer

Ten-year results for two advanced ovarian cancer trials indicate improved overall survival for patients given intraperitoneal treatment

medwireNews: Intraperitoneal (IP) chemotherapy gives a significant survival benefit over 10 years for patients with advanced ovarian cancer compared with intravenous (iv) treatment, demonstrate combined results from two Gynecologic Oncology Group (GOG) trials.

The study included data for 876 patients who were randomly assigned to receive up to six cycles of either GOG protocol 114 comparing iv paclitaxel and iv cisplatin with iv paclitaxel and IP cisplatin, or the GOG 172 protocol comparing iv paclitaxel and iv cisplatin against IP cisplatin and IP paclitaxel.

Over a median of 10.7 years of follow-up, IP therapy was associated with a median survival of 61.8 months versus 51.4 months for iv only treatment, giving an adjusted hazard ratio (HR) of 0.77, report John Chan, from California Pacific/Palo Alto Medical Foundation/Sutter Research Institute in San Francisco, USA, and co-workers.

Factors associated with poor survival after IP therapy included the presence of gross residual disease no larger than 1 cm compared with no visible tumour (HR=1.89), clear cell or mucinous histology versus serous histology (HR=2.79) and incomplete IP therapy leading to iv treatment (HR=1.43). 

Of concern, just 50% of patients completed all cycles of IP therapy because of toxicity or complications.

Nevertheless, each additional IP cycle completed improved survival by 12%, report the researchers. Younger patients were more likely to complete six cycles of IP therapy than older individuals, with a 5% reduction in likelihood of this for each additional year of age.

“[T]he ability to better select patients who are more likely to complete IP therapy with better outcomes and less toxicity warrants further investigation as we move toward individualizing therapies”, John Chan et al conclude in the Journal of Clinical Oncology.

And they now await the findings of the phase III GOG 252 trial, which should shed light on IP approaches incorporating dose-dense paclitaxel, antivascular targeted treatment and maintenance therapy.

In an accompanying editorial, Michael Bookman, from US Oncology Research in The Woodlands, Texas, USA, and Mark Brady, from NRG Oncology Statistical and Data Center in Buffalo, New York, observe that although there is a gain in median overall survival, IP treatment does not represent a cure or affect long-term disease-specific mortality.

Moreover, the survival benefit comes at the “expense of increased complexity, toxicity, and cost”, they write, underlining the need for “new approaches” for patients with advanced disease.

“Important questions remain regarding patient selection (in terms of the extent of residual disease), mechanism of action, treatment modifications, timing, optimal number of IP cycles, and integration with targeted agents”, the editorialists say.

“Some of these questions will be addressed in the context of GOG-0252, and it remains to be seen whether better IV chemotherapy might match the outcomes previously associated with IP chemotherapy.”


Tewari D, Java JJ, Salani R, et al. Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: A Gynecologic Oncology Group study. J Clin Oncol 2015; Advance online publication 23 March. doi:10.1200/JCO.2014.55.9898

Bookman MA, Brady MF. Intraperitoneal chemotherapy: Long-term outcomes revive a long-running debate. J Clin Oncol 2015; Advance online publication 23 March. doi:10.1200/JCO.2014.60.2797

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