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Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer.


ABSTRACT: A 2006 randomized trial demonstrated a 16-month survival benefit with intraperitoneal and intravenous (IP/IV) chemotherapy administered to patients who had ovarian cancer, compared with IV chemotherapy alone, but more treatment-related toxicities. The objective of this study was to examine the use and effectiveness of IP/IV chemotherapy in clinical practice.Prospective cohort study of 823 women with stage III, optimally cytoreduced ovarian cancer diagnosed at six National Comprehensive Cancer Network institutions. We examined IP/IV chemotherapy use in all patients diagnosed between 2003 and 2012 (N = 823), and overall survival and treatment-related toxicities with Cox regression and logistic regression, respectively, in a propensity score-matched sample (n = 402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias.Use of IP/IV chemotherapy increased from 0% to 33% between 2003 and 2006, increased to 50% from 2007 to 2008, and plateaued thereafter. Between 2006 and 2012, adoption of IP/IV chemotherapy varied by institution from 4% to 67% (P < .001) and 43% of patients received modified IP/IV regimens at treatment initiation. In the propensity score-matched sample, IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%; hazard ratio, 0.68; 95% CI, 0.47 to 0.99), compared with IV chemotherapy, but also more frequent alterations in chemotherapy delivery route (adjusted rates discontinuation or change, 20.4% v 10.0%; adjusted odds ratio, 2.83; 95% CI, 1.47 to 5.47).Although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.

SUBMITTER: Wright AA 

PROVIDER: S-EPMC4554746 | biostudies-other | 2015 Sep

REPOSITORIES: biostudies-other

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Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer.

Wright Alexi A AA   Cronin Angel A   Milne Dana E DE   Bookman Michael A MA   Burger Robert A RA   Cohn David E DE   Cristea Mihaela C MC   Griggs Jennifer J JJ   Keating Nancy L NL   Levenback Charles F CF   Mantia-Smaldone Gina G   Matulonis Ursula A UA   Meyer Larissa A LA   Niland Joyce C JC   Weeks Jane C JC   O'Malley David M DM  

Journal of clinical oncology : official journal of the American Society of Clinical Oncology 20150803 26


<h4>Purpose</h4>A 2006 randomized trial demonstrated a 16-month survival benefit with intraperitoneal and intravenous (IP/IV) chemotherapy administered to patients who had ovarian cancer, compared with IV chemotherapy alone, but more treatment-related toxicities. The objective of this study was to examine the use and effectiveness of IP/IV chemotherapy in clinical practice.<h4>Patients and methods</h4>Prospective cohort study of 823 women with stage III, optimally cytoreduced ovarian cancer diag  ...[more]

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