Intraperitoneal (IP) Chemotherapy for Ovarian Cancer
Many of you have asked me about the role of chemotherapy delivered directly in to the abdomen (Intraperitoneal chemotherapy) with ovarian cancer. Here is a quick summary:
1) Results from a large clinical trial suggest a significant survival benefit for Intraperitoneal (IP) chemo as compared to all intravenous chemotherapy in a SUBSET of women with optimally reduced tumor after surgery (to <0.5 cm), but at the expense of significant toxicity.
2) A similar conclusion was reached in two separate meta-analyses of randomized trials comparing standard intravenous therapy with chemotherapy that included a component of IP administration.
3) National Cancer Institute suggests that IP chemotherapy be strongly considered for women with small volume residual tumor after maximal surgical resection for stage III disease. A thorough discussion with the patient about the potential benefits and toxicities associated with such an approach is mandatory. At least for the present, a standard intravenous regimen of paclitaxel plus carboplatin is an acceptable alternative to IP therapy for these patients because of the toxicity issues. Ongoing studies will seek to identify effective yet more tolerable IP regimens for further study in subsequent phase III trials. AGAIN: Women with optimally reduced stage III ovarian cancer and a good performance status should at least be counseled regarding this potentially superior option of therapy.
What about Intraperitoneal Chemo for those with RECURRENCE of ovarian cancer after initial treatment? In a review of salvage therapy for ovarian cancer, Intraperitoneal (IP) therapy with platinum was recommended as second-line therapy for patients with platinum-sensitive relapsed ovarian cancer. However, the basis for this preference is not clear. At present, there seems to be little role for IP chemotherapy in the management of patients with platinum-resistant disease or patients with residual tumors of any size (especially larger than 2 cm).
Confusing I know, but discussing chemotherapy regimens always is. Let us know your experience with IP chemotherapy.
Dr O.
Categories: News
Support Groups: Ovarian Cancer
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I too had IV and IP and completed all six cycles. I will not say it is easy and I do feel fortunate to have completed them, because I know it is not easy for all. I then went through about 6 months of maintenance and then decided I could do no more,.... my doctor wanted a year of maintenance but I just couldn't do it. I am cancer free for now!
By jenfre December 28, 2008 1:33pm
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I went through three rounds of IV and IP chemo, with taxol and cisplatin. Unfortunatley I found it more than I could bare. The pains in my legs and back were horrendous. Plus the fatigue. Also I had trouble with my IP port. I kept bleeding and leaking. The last three were the more tradition IV, with taxol and carboplatin. I wish I could have gone through all 6 with IV and IP. I know the survival rate is greater. I would encourage anyone starting chemo to do this. I know there are other people on DS that have gone through all six like that and handlede it fine. I think I just was not strong enough to begin with. I am six months out of chemo and I am cancer free. I pray I stay that way.
Anita
By anitaama July 19, 2008 8:41am