Combo Rx May Boost Ovarian Cancer Outcomes, But Too Few Get It

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 MONDAY Aug. 3, 2015, 2015 -- Chemotherapy delivered directly into the abdomen significantly improves survival among women with advanced ovarian cancer, a new study finds.
However, fewer than half of U.S. patients who could benefit from this treatment -- called intraperitoneal chemotherapy -- are receiving it, according to Dana-Farber/Brigham and Women's Cancer Center researchers.
The investigators studied whether a combination of intraperitoneal (IP) and intravenous (IV) chemotherapy was as effective in clinical practice as in a clinical trial involving women who'd had surgery for stage III ovarian cancer......

JCO (open access)  Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer

 INTRODUCTION

Several randomized clinical trials have demonstrated that intraperitoneal and intravenous (IP/IV) chemotherapy improves survival in women with optimally resected, stage III ovarian cancer, compared with IV chemotherapy alone.^1–3 In 2006, the National Cancer Institute (NCI) issued a rare Clinical Announcement encouraging IP/IV chemotherapy use after the Gynecologic Oncology Group (GOG) conducted a randomized trial, GOG-172, that demonstrated a 16-month improvement in median overall survival.

To date, however, few studies have examined the impact of this announcement on the use of IP/IV chemotherapy in clinical practice or investigated whether the survival benefit in GOG-172 is representative of outcomes outside of clinical trials.
This is important because fewer than 3% of adult patients with cancer enroll onto clinical trials, and trial participation may be associated with better survival outcomes,^4,5 raising concerns about the generalizability of these findings.^6.......

  In conclusion, our findings suggest that the use of IP/IV chemotherapy at NCCN centers increased significantly after the publication of GOG-172 and the NCI Clinical Announcement. However, fewer than 50% of eligible women received IP/IV chemotherapy overall, and the integration of IP/IV chemotherapy into clinical practice varied significantly among institutions. Despite frequent modifications to the GOG-172 regimen, we found that use of IP/IV chemotherapy in clinical practice is feasible and associated with improved survival compared with IV chemotherapy, consistent with results from randomized trials. Together, these findings suggest that IP/IV is an important and possibly underused, evidence-based treatment strategy for improving outcomes in ovarian cancer. 

 Appendix

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Table A1.

Patient Characteristics After Matching on the Propensity Score for Treatment with IP/IV Chemotherapy versus IV Chemotherapy

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Table A2.

IP/IV Regimens by Institution From 2003 to 2012 (cohort 1)

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Table A3.

Toxicities and Number of IP Chemotherapy Cycles Delivered by Regimen From 2006 to 2012 Off Trial (cohort 2)