Intraperitoneal Chemotherapy in Patients with Advanced Ovarian Cancer: The Con View

Vergote, Ignace; Amant, Frédéric; Leunen, Karin; Cadron, Isabelle; Gorp, Toon Van; Neven, Patrick; Berteloot, Patrick

doi:10.1634/theoncologist.2007-0224

Cited by 21 publications

(8 citation statements)

References 13 publications

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“…In addition, delays in postoperative treatment or compromise of the number of chemotherapy cycles are associated with inferior survival. Furthermore, the rejection of HIPEC falls under the general critique of locoregional therapy for patients with ovarian cancer, traditionally by the same groups who have not been convinced by data supporting postoperative IP treatment [62, 63].…”

Section: Discussionmentioning

confidence: 99%

It's time to warm up to hyperthermic intraperitoneal chemotherapy for patients with ovarian cancer

Zivanovic

Dennis

Filippova

et al. 2018

Gynecologic Oncology

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The peritoneal spread of ovarian cancer makes it a potential target for hyperthermic intraperitoneal chemotherapy (HIPEC). Intraperitoneal delivery exposes the tumor to concentrations of cytotoxic drugs much greater than with intravenous delivery, and in vitro studies have also shown that combining hyperthermia and platinum leads to an additive cytotoxic effect. Pharmacokinetic analyses have confirmed very high concentrations of cytotoxic drugs in the peritoneal cavity, with minimal systemic exposure and toxicity. The majority of historical data evaluating HIPEC in ovarian cancer are based on retrospective research, which included heterogeneous groups of patients and drugs used for HIPEC. Recent publications on the findings of prospective studies, including the first randomized trial in which the only difference in intervention was the addition of HIPEC with cisplatin to interval debulking surgery in stage III patients, have shown a benefit in favor of HIPEC. Yet, a recent prospective study from Korea did not find a benefit. Opponents of HIPEC have cited higher rates of complications with this approach, yet most of the serious adverse events observed are likely related to the surgery itself, and are comparable to the rates reported in studies evaluating cytoreductive surgery without HIPEC. Findings from a recent randomized controlled trial showed no delays in initiation or completion of postoperative chemotherapy in patients treated with HIPEC. A growing body of evidence is indicating that it might be time to seriously consider HIPEC as a complementary treatment at the time of cytoreductive surgery for patients with advanced-stage ovarian cancer in the setting of an experienced center. Yet, more research is needed to identify the population of patients who gain the most benefit from this therapy.

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Section: Discussionmentioning

confidence: 99%

It's time to warm up to hyperthermic intraperitoneal chemotherapy for patients with ovarian cancer

Zivanovic

Dennis

Filippova

et al. 2018

Gynecologic Oncology

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“…Overall survival after salvage CRS and HIPEC versus CRS only in stage III recurrent ovarian cancer with a residual mass less than 1 cm after salvage surgery; p = p = 0.046 (reproduced with permission from 34). every 3 weeks for 6 cycles) [49]. In addition, significant rates of catheter complications were noted with postoperative intraperitoneal chemotherapy [50].…”

Section: Discussionmentioning

confidence: 99%

Survival Benefit of Adding Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) at the Different Time-points of Treatment of Ovarian Cancer: Review of Evidence

Mulier¹,

Claes²,

Dierieck³

et al. 2012

curr pharm des

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The standard treatment for advanced ovarian cancer consists in complete cytoreductive surgery (CRS) and intravenous combination chemotherapy with a platinum compound and a taxane. Although response rates to initial therapy are high, many patients will recur and die of peritoneal carcinomatosis. The addition of Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) to the standard therapy aims at increasing survival by reducing peritoneal recurrence. This review describes the survival results of HIPEC at the different time-points of the treatment of ovarian cancer: at upfront CRS, at interval CRS, at consolidation CRS after complete response to initial therapy, at secondary CRS after incomplete response, at salvage CRS for recurrence and as palliative treatment without CRS for unresectable ovarian cancer with chemotherapy resistant ascites. The available evidence suggests that a potential survival benefit of adding HIPEC may be largest in the settings of secondary CRS for stage III ovarian cancer and salvage CRS for recurrent ovarian cancer, two time-points representing failure of initial standard therapy. There is much less evidence for a potential benefit of HIPEC for less advanced stages (I-II) and for earlier time-points in the treatment of ovarian cancer (upfront, interval and consolidation). Postoperative mortality is not higher after CRS and HIPEC (0.7%) than after CRS only (1.4%). Four randomised trials are ongoing and their results are eagerly awaited. Palliative HIPEC without CRS might be used more in patients with incapacitating ascites due to recurrent ovarian cancer which has become resistant to systemic chemotherapy.

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“…It is important to identify barriers to the use of IV/IP chemotherapy in order to ultimately affect a change in the rate of administration. Editorials, reviews, and surveys of Society of Gynecologic Oncology (SGO) and American Society of Clinical Oncology (ASCO) members have presented general objections providers have to IV/IP chemotherapy (11, 13, 17, 18), but this is the first study evaluating cited reasons in a cohort of patients eligible for IV/IP chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Some of the general objections reported include concern for inadequate treatment of extraperitoneal disease, toxicity, cost, IP port-related impediments, complexity of the regimen, required nursing skills, and increased chemotherapy unit time (6, 11–13). Reported patient factors associated with the use of IV/IP chemotherapy include a younger age and fewer comorbidities (6).…”

Section: Introductionmentioning

confidence: 99%

Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center

Schlappe

Mueller

Zivanovic

et al. 2016

Gynecologic Oncology

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Objective Studies have demonstrated improved ovarian cancer survival with the administration of a combination of intravenous (IV) and intraperitoneal (IP) chemotherapy following optimal cytoreduction. Despite this, IV/IP chemotherapy is not uniformly used. In this retrospective cohort study, we assessed the documented reasons for giving IV-only chemotherapy. Methods All patients who had optimal primary cytoreductive surgery for stage III ovarian, fallopian tube, or primary peritoneal carcinoma, met eligibility criteria for GOG-172, and received primary chemotherapy at our institution between 2006 and 2013 were identified. Patients who received at least one cycle of adjuvant IV/IP therapy were included in the IP group. Patient characteristics, treatment information, and reason cited for not administering IP therapy were collected. Results Of the patients evaluated, 330 met inclusion criteria. The majority (n=261, 79%) received at least one IV/IP cycle (median, 6; range, 1–6), and 62% completed 6 cycles. The most common reason for giving IV-only therapy was postoperative status (i.e., delayed wound healing, performance status), accounting for 18 (26%) of the 69 IV-only patients (5% of the entire cohort). Other cited reasons were baseline comorbidities (15%) and IP port complications (12%). Receipt of ≥1 cycle of IP chemotherapy (HR 0.51; 95% CI, 0.32–0.80) and no gross residual disease (HR 0.47; 95% CI, 0.31–0.71) were associated with improved overall survival. Conclusion Potentially modifiable factors identified as leading to the use of IV-only chemotherapy were postoperative status and IP port complications, which if altered, could potentially lead to increased IP chemotherapy use.

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Intraperitoneal Chemotherapy in Patients with Advanced Ovarian Cancer: The Con View

Cited by 21 publications

References 13 publications

It's time to warm up to hyperthermic intraperitoneal chemotherapy for patients with ovarian cancer

It's time to warm up to hyperthermic intraperitoneal chemotherapy for patients with ovarian cancer

Survival Benefit of Adding Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) at the Different Time-points of Treatment of Ovarian Cancer: Review of Evidence

Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center

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