Intraperitoneal Chemotherapy for Women with Epithelial Ovarian Cancer

Abstract

Learning Objectives After completing this course, the reader will be able to: Assess the rationale behind using i.p. chemotherapy for epithelial ovarian cancer patients and critically evauate the data supporting its use. Interpret the argument that i.p. chemotherapy cannot be accepted as standard of care for first‐line systemic treatment of advanced ovarian carcinoma. Determine which epithelial ovarian cancer patients may be appropriate for i.p. chemotherapy. Avoid and/or manage the toxicities observed with i.p. chemotherapy. Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at http://CME.TheOncologist.com The CME activity for this article consists of material from both “Intraperitoneal Chemotherapy for Women with Epithelial Ovarian Cancer” (Trimble et al.) and “Intraperitoneal Chemotherapy in Patients with Advanced Ovarian Cancer: The Con View” (Vergote et al.).

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Methodology, Drugs and Bidirectional Chemotherapy

“…More recently, bidirectional chemotherapy combining synchronous intraoperative intraperitoneal oxaliplatin and systemic chemotherapy with 5-fluorouracil has been introduced, targeting both the peritoneal cavity and subperitoneal blood vessels, and has shown long-term survival in patients with colorectal cancer and appendix adenocarcinoma. Oncologists acknowledge that disease control may be significantly improved when chemotherapy is administered through the intraperitoneal route [3]. This is supported by extensive clinical and pharmacological research studies and unprecedented therapeutic results have been reported [4][5][6].…”

Evolution of management in peritoneal surface malignancies

“…However, despite the improved median overall survival with this regimen (up to 50 months), recurrence occurs in 75% of patients and 20-30% of these patients might have resistance to the platinum analogues (49). A survival benefit in patients treated with intraperitoneal chemotherapy and systemic chemotherapy as compared to systemic chemotherapy alone was also reported in a phase III trial (50). Intraperitoneal chemotherapy one dose prior to surgery yielded better survival rates than those who had only adjuvant systemic intravenous chemotherapy (51).…”

New challenges for comparative effectiveness in oncology: choice of primary end points for randomized clinical trials

“…Therefore, even treatments that have demonstrated a robust improvement in OS may sometimes struggle for full implementation in practice. For example, intravenously administered chemotherapy continues to be the most commonly used standard of care following cytoreduction surgery for advanced ovarian cancer, even though combined intraperitoneal -intravenous administration has been shown to provide a clear survival improvement: a pooled analysis of seven randomized trials demonstrated a 9-month OS improvement for intraperitoneal -intravenous versus intravenous administration alone [64]. However, intraperitoneal regimens are more toxic, more difficult to administer and require additional supportive care [65].…”