Alternative intraperitoneal chemotherapy regimens for optimally debulked ovarian cancer

• Published in: Gynecologic oncology 2010-03, Vol.116 (3), p.340-344
• Main Authors: Gray, Heidi J, Shah, Chirag A, Swensen, Ron E, Tamimi, Hisham K, Goff, Barbara A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carboplatin; Carboplatin - administration & dosage; Carboplatin - adverse effects; Cisplatin - administration & dosage; Cisplatin - adverse effects; Combined Modality Therapy; Disease-Free Survival; Drug Administration Schedule; Female; Hematology, Oncology and Palliative Medicine; Humans; Infusions, Parenteral; Intraperitoneal chemotherapy; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Obstetrics and Gynecology; Optimal debulking; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2009.10.054

Abstract Objective GOG 172 showed a survival benefit with intraperitoneal (IP) cisplatin for advanced ovarian cancer, but patients tolerated the regimen poorly. We hypothesized that women treated with alternative IP chemotherapy strategies may have less toxicity and improved compliance. Methods We reviewed the records of women with ovarian cancer and optimal surgical debulking who underwent IP chemotherapy at our institution. Primary outcomes analyzed were completion rates and toxicities of IP chemotherapy. Secondary outcomes were progression-free and overall survival. Statistical analysis was performed using STATA 10.0. Results Thirty-nine patients with primary ovarian or peritoneal cancer who underwent IP chemotherapy were identified over a 2 year period. Patients were treated with IV paclitaxel followed by IP cisplatin (64%) or IP carboplatin (36%). Median two cycles of intravenous (IV) taxane and carboplatin were given prior to initiating IP therapy in 77% of patients. Median number of IP chemotherapy cycles was 5 and median total number of cycles was 8. Seventy-four percent (74%) of patients received four or greater cycles of IP chemotherapy. There was a higher rate of completion of intended number of IP cycles in the carboplatin group (92%) versus 60% in the IP cisplatin group ( p = 0.05). Grade 3 non-hematologic toxicities were more common in the IP cisplatin group than in the IP carboplatin group (24% and 0%, p = 0.046). At median follow-up of 24 months, the median progression-free interval and overall survival have not yet been reached for either group. Conclusion Intraperitoneal chemotherapy regimens using carboplatin or cisplatin and dropping day 8 IP paclitaxel have less toxicity and less discontinuation of therapy.