Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer

Abstract

Purpose: A 2006 randomized trial demonstrated a 16-month survival benefit with intraperitoneal and intravenous (IP/IV) chemotherapy administered to patients who had ovarian cancer, compared with IV chemotherapy alone, but more treatment-related toxicities. The objective of this study was to examine the use and effectiveness of IP/IV chemotherapy in clinical practice.

Patients and methods: Prospective cohort study of 823 women with stage III, optimally cytoreduced ovarian cancer diagnosed at six National Comprehensive Cancer Network institutions. We examined IP/IV chemotherapy use in all patients diagnosed between 2003 and 2012 (N = 823), and overall survival and treatment-related toxicities with Cox regression and logistic regression, respectively, in a propensity score-matched sample (n = 402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias.

Results: Use of IP/IV chemotherapy increased from 0% to 33% between 2003 and 2006, increased to 50% from 2007 to 2008, and plateaued thereafter. Between 2006 and 2012, adoption of IP/IV chemotherapy varied by institution from 4% to 67% (P < .001) and 43% of patients received modified IP/IV regimens at treatment initiation. In the propensity score-matched sample, IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%; hazard ratio, 0.68; 95% CI, 0.47 to 0.99), compared with IV chemotherapy, but also more frequent alterations in chemotherapy delivery route (adjusted rates discontinuation or change, 20.4% v 10.0%; adjusted odds ratio, 2.83; 95% CI, 1.47 to 5.47).

Conclusion: Although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.

Fig 1.

Study cohort. IP/IV, intraperitoneal and intravenous; NCCN, National Comprehensive Cancer Network. (*) Propensity scores were overlapping (within 0.5%) for all but one patient who received IP/IV chemotherapy. For the rest of the patients who received IP/IV chemotherapy (n = 201), we obtained one matching patient who received IV chemotherapy using single nearest-neighbor without replacement.

Fig 2.

Proportion of patients treated with intraperitoneal (IP) or intravenous (IV) chemotherapy over time at National Comprehensive Cancer Network centers, 2003 to 2012. GOG, Gynecologic Oncology Group.

Fig 3.

Overall survival with propensity score–matched sample for National Comprehensive Cancer Network patients with optimally cytoreduced, stage III ovarian cancer by first-line chemotherapy administration with intraperitoneal or intravenous (IP/IV) chemotherapy, 2006 to 2012.