Back to Oncology Articles
Wednesday 11th January, 2006
A study featured in Gynecologic Oncology shows the superiority of
intraperitoneal chemotherapy in advanced ovarian cancer.
The National Cancer Institute (NCI), part of the National Institutes
of Health, issued an announcement encouraging treatment with anticancer
drugs via two methods, after surgery, for women with advanced ovarian
cancer. The combined methods, which deliver drugs into a vein and
directly into the abdomen, extend overall survival for women with
advanced ovarian cancer by about a year.
The clinical announcement to surgeons and other medical professionals
who treat women with ovarian cancer was made with the support of six
professional societies and advocacy groups. The announcement coincides
with publication in the New England Journal of Medicine of the results
of a large clinical trial by Deborah Armstrong, M.D., medical oncologist
and an associate professor at Johns Hopkins Kimmel Cancer Center in
Baltimore, Md., and her colleagues in an NCI-supported research network
known as the Gynecologic Oncology Group (GOG). This is the eighth trial
evaluating the use of chemotherapy delivered into the abdomen for
ovarian cancer. Together, these trials show a significant improvement in
survival for women with advanced ovarian cancer.
The two treatment methods are called intravenous, or IV, for
chemotherapy delivered into a vein and intraperitoneal, or IP, for
chemotherapy delivered into the abdominal, or peritoneal, cavity. The
Armstrong trial involved 429 women with stage III ovarian cancer who
were given chemotherapy following the successful surgical removal of
tumors. It compared two treatment regimens: 1) IV paclitaxel followed by
IV cisplatin, to 2) IV paclitaxel followed by IP cisplatin and the
subsequent administration of IP paclitaxel.
"Americans look to NCI--and to all of the institutes that constitute the
National Institutes of Health--for unbiased research studies and sound
counsel. This clinical announcement is a demonstration of that
commitment," said NIH Director Elias A. Zerhouni, M.D.
"The National Cancer Institute wants to make certain that the results of
clinical research are rapidly disseminated to both health care providers
and patients, in order to ensure that life-enhancing cancer treatments
are widely available," said NCI Director Andrew C. von Eschenbach, M.D.
"IP therapy is not a new treatment approach, but it has not been widely
accepted as the gold standard for women with ovarian cancer," said
Armstrong. "There has been a prejudice against IP therapy in ovarian
cancer because it's an old idea, it requires skill and experience for
the surgery and for the chemotherapy, and it's more complicated than IV
chemotherapy. But now we have firm data showing that we should use a
combination of IP and IV chemotherapy in most women with advanced
ovarian cancer who have had successful surgery to remove the bulk of
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Standard treatment for women with stage III ovarian cancer has been
surgical removal of the tumor (debulking), followed by six to eight
courses of IV chemotherapy given every three weeks with a platinum drug,
such as cisplatin or carboplatin, and a taxane drug, such as paclitaxel.
The new NCI clinical announcement recommends that women with advanced
ovarian cancer who undergo effective surgical debulking receive a
combination of IV and IP chemotherapy. IP chemotherapy allows higher
doses and more frequent administration of drugs, and it appears to be
more effective in killing cancer cells in the peritoneal cavity, where
ovarian cancer is likely to spread or recur first.
"In our trial, women who received part of their chemotherapy via an IP
route had a median survival time 16 months longer than women who
received only IV chemotherapy," said Armstrong. The 205 women treated
via the IP route fared better, even though most of them received fewer
than the six planned treatments. Complications associated with the
abdominal catheter used to deliver the IP chemotherapy were the main
reason only 86 of the women completed all six IP treatments. Women who
received IP chemotherapy had more side effects than those treated with
IV chemotherapy alone, but most side effects were temporary and easily
managed. One year after treatment, women in both study groups had the
same reported quality of life.
"Randomized, multicenter clinical trials, including this most recent
study, clearly show the value of IP chemotherapy--an extended life for
women with advanced ovarian cancer," said Philip DiSaia, M.D., chairman
of the GOG.
"For most women who have had successful surgical removal of tumors to
less than one centimeter in size, we now know that the longest survival
may be achieved by giving their chemotherapy directly into the abdomen,"
said Beth Karlan, M.D., president of the Society of Gynecologic
Oncologists and director of Gynecologic Oncology and the Gilda Radner
Ovarian Cancer Program at Cedars-Sinai Medical Center in Los Angeles,
In response to this announcement, the Ovarian Cancer National Alliance's
outgoing president, Ginger Ackerman, and its executive director, Sherry
Salway Black, said the Alliance would widely disseminate this
information on IP therapy to their patient community. "We welcome the
results of the recent trial that demonstrates increased survivorship,"
said Salway Black.
"It is important for women to have the facts about when it is
appropriate to consider IP chemotherapy," said Karl Podratz, M.D.,
Ph.D., chairman of the board of the Gynecologic Cancer Foundation (GCF)
and professor of obstetrics and gynecology at the Mayo Clinic,
Rochester, Minn. "GCF looks forward to working with NCI and the ovarian
cancer community to educate women about the results of this very
important clinical trial, and what it means for women with advanced
Karen Stanley, R.N., M.S.N, president of the Oncology Nursing Society,
and Susan Vogt Temple, R.N., president of the Society of Gynecologic
Nurse Oncologists, noted that their societies have plans in place to
teach oncology nurses and women with ovarian cancer how IP chemotherapy
can be given safely and reliably.
More studies are needed to determine the best IP drug regimen and the
optimal number of IP treatments. Future trials also will address how to
reduce toxicity associated with IP administration.
In addition to continued research to improve ovarian cancer treatment,
NCI is funding studies to identify disease markers and develop improved
screening techniques, enabling earlier detection and treatment of the
disease. An estimated 22,220 women in the United States were diagnosed
with ovarian cancer in 2005. It causes more deaths in the United States
than any other cancer of the female reproductive system, with an
estimated 16,210 women dying from the disease in 2005. The most recent
statistics show that only 45 percent of women survive five years after
being diagnosed with ovarian cancer; the rate increases to 94 percent
when the disease is diagnosed before it has spread. However, women with
ovarian cancer frequently have no symptoms or only mild symptoms until
the disease is advanced. As a result, only 19 percent of all cases are
detected at that early, localized stage.
About Ovarian Cancer
Ovarian cancer is the most deadly form of gynecologic cancer.
According to the American Cancer Society, an estimated 22,220 American
women are expected to be diagnosed with ovarian cancer in 2005 and more
than 16,000 of these women are expected to die from the disease. The
Ovarian Cancer National Alliance reports that approximately 50 percent
of women diagnosed with ovarian cancer die from it within five years.
However, nearly 75 percent of ovarian cancer cases are diagnosed in
later stages when the disease is more difficult to treat and the chance
of five-year survival is only about 25 percent.
Armstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R, Lele S,
Copeland LJ, Walker JL, Burger RA. Intraperitoneal cisplatin and
paclitaxel in ovarian cancer. NEJM, January 5, 2006, Vol. 354, No. 1,