Intraperitoneal chemotherapy has survival benefits
Women with ovarian cancer treated with intraperitoneal as well as intravenous
chemotherapy after surgery survive longer than women treated only with
intravenous therapy post-surgery, a new trial reveals.
Treatment regimens
Patients received 135mg of intravenous paclitaxel
per m2 of body surface area over a 24-hour period
followed by either 75mg of IV cisplatin per m2 on
day 2 or 100mg of intraperitoneal cisplatin per m2 on
day 2 and 60mg of intraperitoneal paclitaxel per m2 on
day 8. Treatment was given every three weeks for six cycles.
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Researchers compared
the two approaches to treatment (see Panel) in a randomised study involving
415 patients.
The median duration of both progression-free and overall survival was
increased among those who received intraperitoneal therapy (a benefit
of 5.5 and 15.9 months, respectively), despite only 42 per cent of these
patients completing the course of treatment.
Adverse effects were reported more frequently for patients in the intraperitoneal
group and quality of life was worse for these patients up to six weeks
after treatment. However, the researchers note that one year after treatment
quality of life scores were similar for each group (New England Journal
of Medicine 2006;354:34).
The author of an accompanying editorial suggests ways in which the tolerability
of intraperitoneal therapy may be improved: reduction of the dose of
intraperitoneal cisplatin on day 2, administration of intravenous paclitaxel
on day 1 over three hours instead of 24 hours, or omission of intraperitoneal
paclitaxel on day 8 until tolerance of the first cycle of intraperitoneal
cisplatin can be assessed. “Although these measures are reasonable,
it is unknown whether they will reduce the toxic effects and still preserve
the benefits of the intraperitoneal approach,” the author says
(ibid, p77). |
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