Intraperitoneal chemotherapy for ovarian cancer: where are we now?

Patients with advanced epithelial ovarian cancer are conventionally treated with intravenous (IV) platinum- and taxane-based chemotherapy to try to eradicate residual disease after optimal cytoreductive surgery, resulting in a median overall survival of 49 months. The Gynecologic Oncology Group (GOG) conducted 3 large randomized, phase III clinical trials of intraperitoneal (IP) chemotherapy (GOG 104, 114, and 172) that clearly showed superior progression-free and overall survival with IP chemotherapy compared with IV chemotherapy. All 3 clinical trials investigated IP cisplatin, with the last one adding IP paclitaxel. The most recent study (GOG 172) resulted in a median survival of 66 months for patients in the IP arm versus 50 months for those in the IV arm. Fewer patients in the IP arm than in the IV arm completed all 6 treatment cycles (42% vs. 83%, respectively) because of the toxic effects of chemotherapy and IP catheter-related complications. Initially, patients in the IP arm reported significantly worse quality of life than those in the IV arm. However, at 12-month follow-up, the groups experienced no difference in quality of life, except that paresthesias were more likely to persist at moderate levels among patients in the IP arm. Based on these clinical trials, the National Cancer Institute issued a clinical announcement recommending that women with stage III ovarian cancer who undergo optimal surgical cytoreduction be considered for IP chemotherapy.