Preferred treatment method for advanced ovarian cancer announced

The National Cancer Institute (NCI), part of the National Institutes of Health, has issued an announcement encouraging treatment with anticancer drugs via two methods, after surgery, for women with advanced ovarian cancer.

The combined methods, which deliver drugs into a vein and directly into the abdomen, extend overall survival for women with advanced ovarian cancer by about a year.

The Siteman Cancer Center participated in the NCI-supported research leading to the announcement.

Coinciding with the NCI’s announcement, the New England Journal of Medicine published the results of a recent clinical trial in an NCI-supported research network known as the “Gynecologic Oncology Group” (GOG), of which the University is a member. The trial was the eighth to evaluate the use of chemotherapy delivered into the abdomen for ovarian cancer.

Together, these trials show a significant improvement in survival for women with advanced ovarian cancer.

“There are pros and cons to this type of treatment,” said David G. Mutch, M.D., director of the WUSTL Division of Gynecologic Oncology. “The benefits and risks should be discussed with the treating physician, but this modality offers significant benefits in a select group of patients.”

The two treatment methods are called intravenous (IV) chemotherapy — delivered into a vein — and intraperitoneal (IP) chemotherapy — delivered into the abdominal, or peritoneal, cavity.

The trial involved 429 women with stage III ovarian cancer. They were given chemotherapy following the successful surgical removal of tumors.

The trial compared two treatment regimens: IV paclitaxel followed by IV cisplatin; with IV paclitaxel followed by IP cisplatin and the subsequent administration of IP paclitaxel.

“IP therapy is not a new treatment approach, but it has not been widely accepted as the gold standard for women with ovarian cancer,” said lead author Deborah Armstrong, M.D., medical oncologist and associate professor at Johns Hopkins Kimmel Cancer Center.

“There has been a prejudice against IP therapy in ovarian cancer because it’s an old idea, it requires skill and experience for the surgery and for the chemotherapy, and it’s more complicated than IV chemotherapy.

“But,” Armstrong added, “now we have firm data showing that we should use a combination of IP and IV chemotherapy in most women with advanced ovarian cancer who have had successful surgery to remove the bulk of their tumor.”

According to the NCI, an estimated 22,220 women in the United States were diagnosed with ovarian cancer in 2005. It causes more deaths in the United States than any other cancer of the female reproductive system, with an estimated 16,210 women dying from the disease in 2005.

The most recent statistics show that only 45 percent of women survive five years after being diagnosed with ovarian cancer; the rate increases to 94 percent when the disease is diagnosed before it has spread. However, women with ovarian cancer frequently have no symptoms or only mild symptoms until the disease is advanced.

Standard treatment for women with stage III ovarian cancer has been surgical re-moval of the tumor (debulking), followed by 6-8 courses of IV chemotherapy given every three weeks with a platinum drug, such as cisplatin or carboplatin, and a taxane drug, such as paclitaxel. (Platinum and taxane are two classes of anticancer drugs.)

The new NCI clinical announcement recommends that women with advanced ovarian cancer who undergo effective surgical debulking receive a combination of IV and IP chemotherapy. IP chemotherapy allows higher doses and more frequent administration of drugs, and it appears to be more effective in killing cancer cells in the peritoneal cavity, where ovarian cancer is likely to spread or recur first.

“In our trial, women who received part of their chemotherapy via an IP route had a median survival time 16 months longer than women who received only IV chemotherapy,” Armstrong said.

“Randomized, multicenter clinical trials, including this most recent study, clearly show the value of IP chemotherapy — an extended life for women with advanced ovarian cancer,” said Philip DiSaia, M.D., chairman of the GOG.

The 205 women treated via the IP route fared better, even though most of them received fewer than the six planned treatments. Complications associated with the abdominal catheter used to deliver the IP chemotherapy were the main reason only 86 of the women completed all six IP treatments.

Women who received IP chemotherapy had more side effects than those treated with IV chemotherapy alone, but most side effects were temporary and easily managed. One year after treatment, women in both study groups had the same reported quality of life.

More studies are needed to determine the best IP drug regimen and the optimal number of IP treatments. Future trials also will address how to reduce toxicity associated with IP administration.