Injecting anti-cancer drugs into the body cavity, not just into a vein, can dramatically lengthen the lives of women with advanced ovarian cancer, a study showed on Wednesday.
The U.S. government quickly recommended that patients start getting the new treatment for the disease that is the fourth-leading cause of cancer-related deaths among women in the United States.
The treatment can be difficult to endure but improved the average survival time by nearly 16 months and cut the risk of death from advanced ovarian cancer by 25 percent, said the study published in this week’s New England Journal of Medicine.
“It’s very good news,” said Deborah Armstrong, chief author of the study. “A lot of larger institutions have already adopted this approach. At least for today, this is the best thing we can offer our patients.”
Each year, ovarian cancer strikes about 22,000 U.S. women and 16,000 die from it, according to the American Cancer Society.
The study produced “one of the largest benefits ever observed for a new therapy in gynecologic oncology,” said Stephen Cannistra in a journal editorial.
SURVIVAL TIME 32 PERCENT LONGER
In advanced cases of ovarian cancer, surgeons try to remove the visible tumor and use intravenous chemotherapy to kill cancer cells too small to see.
When they cannot get it all, most women die after about three years. But even surgery deemed a success usually adds only one extra year of life.
Armstrong of Johns Hopkins Kimmel Cancer Center in Baltimore and her colleagues gave 210 cancer patients standard chemotherapy with two drugs, cisplatin and paclitaxel.
Another 205 received paclitaxel intravenously followed by cisplatin and then more paclitaxel, both injected into the body cavity with water to flush the drug throughout the peritoneum, the tissue that lines the abdominal wall and covers most of the organs in the abdomen.
The treatments were repeated five more times, three weeks apart.
Women who received intraperitoneal chemotherapy directly into their body cavity typically survived for 66 months, 32 percent longer than those receiving standard care.
However, the body cavity treatment often caused pain, fatigue, stomach, intestinal and other problems so severe that 58 percent of the patients did not get the full six courses of therapy.
The quit rate was 17 percent among those who only received their drugs intravenously.
The National Cancer Institute on Wednesday recommended simultaneous delivery of chemotherapy drugs intravenously and directly through the abdomen after surgery for ovarian cancer.
Intraperitoneal chemotherapy “allows higher doses and more frequent administration of drugs, and it appears to be more effective in killing cancer cells in the peritoneal cavity, where ovarian cancer is likely to spread or recur first,” said the institute, the cancer research arm of the National Institutes of Health.
One year after receiving their treatments, the women in both groups had the same quality of life, the study said.
“It is remarkable that such a clinically meaningful survival advantage was observed, despite the high attrition rate” in the group that received the drugs in the body cavity, said Cannistra of the Beth Israel Deaconess Medical Center in Boston. That suggests “a substantial benefit” from the treatment, even when it is only given a few times.
Revision date: June 21, 2011
Last revised: by Sebastian Scheller, MD, ScD