Patients with advanced ovarian cancer who had the chemotherapy drug topotecan administered directly into their abdominal cavity survived for a median of three years without cancer recurrence, according to results presented at the 23rd annual Chemotherapy Foundation Symposium.
Approximately 25,000 new cases of ovarian cancer are diagnosed in the U.S. each year. Patients with stage III or stage IV ovarian cancer are considered to have advanced disease. 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. Debate about the benefits of this approach continues among gynecologic oncologists. Research is now emerging, however, that intraperitoneal chemotherapy given after other types of therapy may benefit select patients with ovarian cancer since ovarian cancer commonly spreads within the peritoneal cavity. Researchers continue to explore the optimal use of intraperitoneal chemotherapy.
In order to evaluate intraperitoneal treatment with the chemotherapy drug topotecan, researchers at the Virginia Mason Medical Center in Seattle conducted a phase II clinical trial among 20 patients with stage III or stage IV ovarian cancer. Patients received intraperitoneal topotecan after initial treatment with the chemotherapy drugs paclitaxel and carboplatin. Only women who had minimal remaining cancer after treatment with paclitaxel and carboplatin were enrolled in the study.
The researchers reported the following results:
- 60% of patients were able to receive 4 to 6 cycles of full-dose therapy.
- On second-look surgery, half of the patients had no detectable residual cancer.
- At a median of 18 months following second-look surgery, 19 of the 20 patients were alive, and 70% had no evidence of cancer.
- Patients survived without cancer recurrence for a median of three years after diagnosis.
- Blood disorders were the most common adverse effect of treatment. In general, treatment was well tolerated.
The researchers concluded that intraperitoneal topotecan given after initial treatment with paclitaxel and carboplatin appears to produce acceptable outcomes in women with advanced ovarian cancer. This study only evaluated women with minimal remaining cancer after treatment with paclitaxel and carboplatin. Because treatment was well tolerated, the researchers suggest that additional cycles of intraperitoneal topotecan may provide even greater relapse-free survival in these patients.
Reference: Muntz H, McGonigle K, Malpass T, et al. Phase II Study of Intraperitoneal Topotecan as Consolidation Chemotherapy in Ovarian and Primary Peritoneal Cancer. Proceedings from the 23rd annual Chemotherapy Foundation Symposium. November 2005. New York. Abstract #48.