Intraperitoneal Chemotherapy for Epithelial Ovarian Cancer

As ovarian cancer spreads over the surface of the peritoneum and often recurs at this site, investigators have evaluated intraperitoneal (IP) administration of chemotherapy that can achieve high local concentrations of drug. A randomized, prospective trial performed by the Southwest Oncology Group (SWOG) and the GOG compared IP cisplatin (100 mg/M₂) to IV cisplatin (100 mg/M₂), each given with II cyclophosphamide (600mg/M₂), in patients with disease less than 2 cm in diameter. The intraperitoneal cisplatin arm had a significantly longer overall median survival than the intravenous arm, 49 versus 41 months (p = .03). In the patients with the least residual disease (< 0.5 cm maximum residual), however, there was not a statistically significant difference in median survival between the two treatments, 51 versus 46 months (p = .08).

Results of this randomized trial became available as paclitaxel was being incorporated into clinical practice. In a follow-up trial conducted by the GOG, a standard regimen of IV cisplatin (75 mg/M₂) and IV paclitaxel (135 mg/M over 24 h) was compared to a dose-intense regimen that was initiated by giving moderately high-dose carboplatin (AUC=9) for two induction cycles followed by IP cisplatin 100 mg/M₂ and IV paclitaxel (135 mg/M₂ over 24 h). The dose-intense arm produced slightly better progression-free median survival (27.6 months vs 22.5 months, p = .02), but there was not a statistically significant difference in overall survival (52.9 months vs 47.6 months, p = .056).

A randomized prospective GOG study is comparing IP cisplatin and paclitaxel to IP cisplatin and paclitaxel. Based on results of currently available studies, the value of intraperitoneal chemotherapy in the primary treatment of optimally resected stage III ovarian cancer remains unclear.