August 4, 2015 | by Tami Dennis
Delivering chemotherapy directly to the abdomen in women with advanced ovarian cancer is part of an effective treatment regimen that’s too little used. That’s the conclusion of a new study published in the Journal of Clinical Oncology.
The technique, known as intraperitoneal, or IP, chemotherapy, has been linked to extended survival when delivered with traditional intravenous, or IV, chemotherapy. In fact, the National Cancer Institute in 2006 actively encouraged use of intraperitoneal chemotherapy for ovarian cancer in the wake of a study concluding that women who received the combination approach had a 16-month improvement in median overall survival.
City of Hope experts are well-versed in the regimen and offer IP chemotherapy to appropriate patients. But, says the new study by researchers at City of Hope and elsewhere, fewer than 50 percent of eligible patients in a recent study of select institutions received IP/IV chemotherapy. “Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes,” wrote the study authors, which included City of Hope's Mihaela Cristea, M.D., associate clinical professor of medical oncology, and Joyce C. Niland, Ph.D., the Edward and Estelle Alexander Chair in Information Sciences.
Robert J. Morgan, M.D., co-director of the gynecological cancers program at City of Hope has been chair of the National Comprehensive Cancer Network's Ovarian Cancer Guidelines Panel for 20 years. He agreed that IP chemotherapy should be offered to many more women, but noted that many doctors may feel that the increased toxicity, length of treatment, and difficulty of administration is not adequately compensated by the improvements in outcomes.
He elaborated on when and how intraperitoneal chemotherapy for ovarian cancer should be delivered:
1. In general it is just as important that the nurses be familiar with the administration and potential toxicity and complications of IP chemotherapy as the doctors are because they are on the front lines, and if a complication occurs they need to know when to hold the IP administration and have the doctor evaluate. If nursing is unfamiliar, it is safer for the patient to receive IV chemotherapy or go to an institution familiar with this form of administration.
2. Patients who are not optimally debulked may not benefit from this form of treatment, although it is my feeling that this is still a research question.
3. Patients who have multiple adhesions may not benefit due to the inability of the chemotherapy to flow freely within the abdomen.
4. Some patients simply do not tolerate the volume (2 liters) of fluid in which the chemotherapy must be administered for optimal results.
5. One of the major complications is portacath malfunction. The problem here is that our bodies develop fibrin sheaths over the catheters which can cause them to malfunction ... We really need better ways to administer the chemotherapy drugs.
6. Other potential toxicities include infections of the port. I think that numbers 5 and 6 are decreased with increased experience of the nurses and doctors administering this form of treatment.
Overall, treatment of ovarian cancer is improving, with the National Comprehensive Cancer Network recently releasing the 20th edition of its guidelines for ovarian cancer treatment.
IP chemotherapy was featured prominently in these guidelines, and Morgan highlighted IP chemotherapy as one of the most notable advances. “IP chemo can be very effective, and you need a team with the ability, knowledge and skill to do it,” he said.
The kind of team at City of Hope.
** Read more about ovarian cancer treatment, including intraperitoneal chemotherapy, at City of Hope.
** Learn more about making your first appointment or getting a second opinion or call 800-826-HOPE (4673). You may also request a new patient appointment online.