Little-used ovarian cancer therapy boosts survival.(Gynecology)

A clinical announcement issued by the National Cancer Institute on intraperitoneal chemotherapy for ovarian cancer should win the treatment widespread and overdue acceptance, predict physicians who have administered the treatment for years.

"With the coming of age of [the taxane drugs], physicians were so hopeful about newer drugs that everyone wanted to ignore the data (showing improved survival with intraperitoneal administration)," said Dr. Joan L. Walker, chief of gynecologic oncology at the University of Oklahoma, Oklahoma City. "Many medical oncologists also don't want to deal with catheters .... It's almost as if we all had to be forced to do it."

In its first clinical announcement issued since 1999, the NCI said that results of several large phase III randomized trials published over the past 10 years--as well as several smaller randomized studies--have shown an increase in median survival of at least a year for women who had successful surgical cytoreduction (debulking) and who were then given chemotherapy via a combined intravenous-intraperitoneal approach as opposed to the standard intravenous-only approach.

The most recent of these trials showed a 16-month improvement in median overall survival in 205 women who received combined intravenous-intraperitoneal chemotherapy. According to the NCI, the study was strong and free of the complexities of earlier studies.

The NCI issued the announcement "based on these combined results" and because intraperitoneal (IP) chemotherapy "has not been adopted into standard practice" despite the published evidence of efficacy, according to NCI statements and a "Q&A" posted on the Internet (http://ctep.cancer.gov/highlights/ovarian.html).

The "best data sources" suggest that less than 1% of women with ovarian cancer receive IP chemotherapy, NCI said. The treatment was first proposed several decades ago because residual ovarian cancer after surgery and initial recurrences are primarily confined to the abdomen.

Many women, moreover, are not undergoing optimal surgical debulking to minimal or no gross residual disease, which is the first step to improved survival and an important prerequisite for chemotherapy, according to the NCI.