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In response to a demonstrated 16-month survival advantage with intravenous and intraperitoneal (IV/IP) chemotherapy, the National Cancer Institute issued a statement in 2006 encouraging use of IV/IP chemotherapy for optimally cytoreduced stage III epithelial ovarian cancer. Using information from the National Comprehensive Cancer Center Network Ovarian Cancer Outcomes Database, investigators assessed practice patterns at six comprehensive cancer centers from 2003 to 1012. A total of 823 patients with cytoreduced stage III epithelial ovarian cancer were identified; primary outcomes were the proportion of patients receiving IV/IP chemotherapy and overall survival.
Overall, 35% of patients received IV/IP chemotherapy. Use of IV/IP rose from 0% in 2003 to almost 50% by 2008, but then plateaued. Patients who received IV/IP were younger and had fewer comorbidities than those who received IV alone. However, the key predictor of IV/IP usage was institution. As in previous trials of IV/IP chemotherapy, women who received the combined regimen experienced more toxicity, greater need to change therapy, and fewer completed cycles than those who received IV alone. Survival was significantly greater in the IV/IP group than the IV group (3-year overall survival, 81% vs. 71%; hazard ratio, 0.68).
Wright AA et al. Use and effectiveness of intraperitoneal chemotherapy for treatment of ovarian cancer. J Clin Oncol 2015 Aug 3; [e-pub]. (http://dx.doi.org/10.1200/JCO.2015.61.4776)
Comment
Although IV/IP chemotherapy has proven survival benefits in stage III optimally cytoreduced ovarian cancer, its uptake into clinical practice has been disappointing. Factors underlying limited use of this combined regimen include logistic constraints, concerns about reimbursement, patients' preferences, interest in other regimens (e.g., dose-dense IV paclitaxel), unfamiliarity with the regimen, and physicians' apprehensions about tolerability. To help overcome these barriers, we need more information about the practice habits of gynecologic and medical oncologists who focus on ovarian cancer. Many oncologists who use IP/IV regimens have incorporated modifications not yet evaluated in clinical trials. Physicians who care for women with ovarian cancer should evaluate their own practice patterns to assure that their patients receive best-practice care.