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According to an article recently published in the New England Journal of Medicine, chemotherapy administered directly into the peritoneal (abdominal) cavity in addition to intravenous chemotherapy improves survival by nearly 1.5 years for patients with stage III ovarian cancer.

Approximately 25,000 new cases of ovarian cancer are diagnosed in the U.S. each year. Patients with stage III ovarian cancer are considered to have advanced disease, as their cancer has spread from the ovaries. Standard treatment for advanced ovarian cancer involves the surgical removal of as much cancer as possible (if a patient is eligible for surgery), as well as chemotherapy and/or radiation therapy.

Intraperitoneal chemotherapy involves the administration of a chemotherapy drug directly into the abdominal cavity. Ovarian cancer commonly spreads within the peritoneal cavity, and researchers have speculated that more direct administration of chemotherapy to the sites of cancer may provide benefit over intravenous (administration into the vein) treatment only. Debate about the benefits of this approach has been ongoing among gynecologic oncologists.

Researchers affiliated with the Gynecologic Oncology Group (GOG) have recently completed a phase III trial directly comparing intravenous chemotherapy plus intraperitoneal chemotherapy to intravenous chemotherapy alone in patients with stage III ovarian cancer. This trial included 415 patients, all of whom had no cancerous masses greater than 1.0 cm in diameter following surgery to remove as much cancer as possible. Following surgery, patients were treated with either intravenous paclitaxel (Taxol®) plus cisplatin (Platinol®) only, or intravenous paclitaxel plus intraperitoneal paclitaxel/cisplatin.

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Patients treated with the addition of intraperitoneal chemotherapy had significantly improved outcomes:

• Median duration of progression-free survival was 18.3 months in patients treated with intravenous chemotherapy only, compared with 23.8 months for those treated with intraperitoneal chemotherapy.

• Median duration of overall survival was improved by approximately 16 months in patients treated with intraperitoneal chemotherapy (49.7 months for patients treated with intravenous chemotherapy only, versus 65.6 months for those treated with intraperitoneal chemotherapy).

• During treatment, patients who received intraperitoneal chemotherapy had a greater incidence of serious side effects (pain, fatigue, low blood cell levels, gastrointestinal side effects, metabolic side effects, neurologic side effects) and had a reduced quality of life. However, one year after treatment, quality of life was similar between the two groups of patients.

The researchers concluded that the addition of intraperitoneal chemotherapy to intravenous chemotherapy significantly improves progression-free survival and overall survival in patients with stage III ovarian cancer. Women with ovarian cancer should speak with their physician prior to surgery to determine if they may be eligible for intraperitoneal therapy, as surgery may have to be tailored to allow benefit of this treatment approach. Patients may also wish to speak with their physician regarding the individual risks and benefits of a clinical trial further evaluating different doses or treatment regimens for intraperitoneal chemotherapy.

Reference: Armstrong D, Bundy B, Wenzel L, et al. Intraperitoneal Cisplatin and Paclitaxel in Ovarian Cancer. New England Journal of Medicine. 2005; 354:34-43

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