SATURDAY, March 9 (HealthDay News) -- Women with advanced
ovarian cancer who receive intense chemotherapy directly into their
stomach area may live at least one year longer than women who
receive standard intravenous chemotherapy, a new study says.
But this survival edge may come at the expense of more side
"The long-term benefits are pretty significant," said study author Dr. Devansu Tewari, director of gynecologic oncology at the Southern California Permanente Medical Group, in Orange County. "There is no study of ovarian cancer treatments that has shown a greater survival advantage."
Intraperitoneal chemotherapy involves bathing the abdominal area
with chemotherapy agents. By contrast, intravenous (IV)
chemotherapy is delivered throughout the body via the bloodstream.
The U.S. National Cancer Institute currently recommends
intraperitoneal therapy for women with ovarian cancer who have had
successful surgery to remove the tumor.
The 10-year follow-up data from two studies of nearly 900 women
with advanced ovarian cancer will be presented Saturday at the
annual meeting of the Society of Gynecologic Oncology, in Los
In 2013, more than 22,000 American women will be diagnosed with
ovarian cancer, and more than 14,000 will die from the disease,
according to the U.S. National Cancer Institute. There are no early
screening tests for ovarian cancer, which is why it is often
diagnosed when the cancer has already spread outside of the
ovaries. For this reason, survival rates tend to be very low.
In the new study, women who received the intraperitoneal
treatment were 17 percent more likely to survive longer than those
who got IV chemotherapy. On average, women in the intraperitoneal
group survived for more than five years, while those who received
IV chemotherapy survived for about four years, the study found.
But survival benefits aside, intraperitoneal chemotherapy does
confer a greater risk of side effects -- such as abdominal pain and
numbness in the hands and feet -- and not all women can tolerate
this high concentration of cancer-killing drugs. The drugs are also
absorbed more slowly, providing more exposure to the medicine. The
same properties that make the intraperitoneal therapy more
effective likely play a role in causing more side effects, the
In general, six cycles of intraperitoneal chemotherapy are
recommended, and can be given in inpatient or outpatient settings.
The more cycles the women completed, the greater their survival
advantage, the study showed. After five years, close to 60 percent
of women who completed five or six cycles of intraperitoneal
therapy were still alive, compared with 33 percent of those who
completed three or four cycles and 18 percent of those who
completed one or two cycles. Women can switch back to IV
chemotherapy if the side effects prove too harsh. Still, the
researchers said, some intraperitoneal chemotherapy is better than
Younger and healthier women were among the most likely to
complete the regimen.
"If after surgery all of the visible cancer has been removed and there is no cancer that is greater than 1 centimeter left in any one area, a woman is an immediate candidate [for intraperitoneal chemotherapy]," Tewari said. "If someone is older and in good shape and handled the operation well, they are also candidates."
Growing numbers of doctors and women with ovarian cancer are
opting for intraperitoneal therapy, she said. And it may offer even
greater benefits when paired with some of the newer therapies for
ovarian cancer that are moving through the drug development
"Its use can and should increase," said Tewari, who also is an assistant professor of obstetrics and gynecology at the University of California, Irvine, School of Medicine.
Dr. Jubilee Brown, a spokeswoman for the Society of Gynecologic
Oncology and an associate professor of gynecologic oncology at the
University of Texas MD Anderson Cancer Center, said the new
findings are exciting.
"This is long-term follow-up data that confirms what we expected," Brown said. "We have been waiting for years to determine if the results are short-lived or if we see it years later, and now we know that we see the survival benefit 10 years out."
"Doctors are used to giving IV chemotherapy, so this is a new skill set in terms of giving the drugs," she said. "It comes with different equipment and patient instructions and side effects. As individual physicians and centers become more comfortable and confident with learning how to manage the side effects, its use will increase."
Dr. Elizabeth Poynor, a gynecologic oncologist at New York
City's Lenox Hill Hospital, agreed. "The toxicity and intensity is
greater than with IV therapy, so some people can't tolerate it,"
she said. "But for those who do, survival is clearly
"It's a tradeoff," Poynor said. "There are more side effects, but there are also survival benefits. You don't know how you will tolerate it until you try -- and if it's not for you, you can back off."
Because this study was presented at a medical meeting, the data
and conclusions should be viewed as preliminary until published in
a peer-reviewed journal.
Learn more about
treatment for ovarian cancerat the U.S. National
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