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Debate 15B - Is there a Role for Intraperitoneal Chemotherapy after Optimal Cytoreduction of Ovarian Cancer?

No

from Section III - Ovarian Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

Intraperitoneal (IP) chemotherapy, the delivery of unheated chemotherapy into the peritoneal cavity through a catheter connected to an implanted port, was once a strongly recommended, though controversial, treatment for women with advanced ovarian cancer after optimal cytoreductive surgery. Historically, direct drug delivery to the IP cavity and improved pharmacokinetics yielded improved progression-free and overall survival outcomes. However, the improved disease control and survival came at the cost of significantly increased toxicity, worse quality of life, and added expense. The most recent randomized clinical trial of IP therapy identified a less toxic regimen but failed to demonstrate any survival benefit. The negative results of this study, taken in the setting of more recent advances in biologic therapies, illustrate that in the modern therapeutic landscape for ovarian cancer there is no role for IP chemotherapy. IP therapy is too toxic, too expensive, and historical IP therapy survival outcomes are no longer relevant.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Tewari, D, et al. Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study. J Clin Oncol 2015;33:14601466.CrossRefGoogle ScholarPubMed
Walker, JL, et al. Randomized trial of intravenous versus intraperitoneal chemotherapy plus bevacizumab in advanced ovarian carcinoma.J Clin Oncol 2019;37(16):13801390. https://doi.org/10.1200/JCO.18.01568CrossRefGoogle ScholarPubMed
Wright, JD, et al.Utilization and toxicity of alternative delivery methods of adjuvant chemotherapy for ovarian cancer. Obstet Gynecol 2016;127(6):985991.Google Scholar
Havrilesky, LJ, et al. Gynecologic Oncology Group. Cost effectiveness of intraperitoneal compared with intravenous chemotherapy for women with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2008;26(25):41444450.CrossRefGoogle ScholarPubMed

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