Ovarian Cancer IP Chemotherapy

IP chemotherapy has yielded promising results when used in combination with standard IV therapy in the first-line setting for advanced ovarian cancer. Improvement in overall survival has been documented in prospective randomized controlled trials, with attainment of median OS of 66.9 months, the longest ever reported to date in advanced ovarian cancer patients. IP therapy was associated with increased toxicity and difficulty administering all scheduled doses, due to catheter complications and possibly due to the higher doses of cisplatin used IP. Catheter complications may be reduced if port-a-caths are used preferentially over Tenckhoff catheters, and are placed laparoscopically or under radiologic guidance, though prospective data are needed to definitively address these issues. Strategies to decrease chemotherapy related toxicities include the substitution of cisplatin with carboplatin or the use of cytoprotectants like amifostine. In addition, further evaluation for the use of IP carboplatin is necessary. Currently the GOG is conducting studies evaluating the feasibility of administering IP carboplatin with IV
paclitaxel (GOG 9917) and IP carboplatin with paclitaxel (IV and IP) or IP carboplatin, IP paclitaxel and IV docetaxel (GOG 9916). Due to the possible relationship between recent major abdominal surgery and administration of IP chemotherapy, it has been suggested that delaying IP chemotherapy until the second cycle may be better tolerated. Due to the clear advantage in OS, the use of IP chemotherapy needs to be strongly considered for patients with optimally
debulked ovarian cancer, despite the increased toxicity.