Old idea fights ovarian cancer

Delivering chemotherapy directly into the abdomen improves survival in women with advanced ovarian cancer, a new study shows.

Doctors randomly assigned 415 women with ovarian cancer that was spreading to nearby tissues to receive either standard chemotherapy intravenously or that therapy plus up to six courses, at 3-week intervals, of chemotherapy injected into the abdomen via a catheter. This approach is available for cancer treatment, but few doctors use it. The drugs used in the new study were cisplatin and paclitaxel (Taxol).

The median survival time for the 205 women getting the abdominal infusions was 66 months, the longest ever recorded for a group treated for this stage of ovarian cancer, the researchers report in the Jan. 5 New England Journal of Medicine. Median survival time was 50 months for women getting only intravenous chemotherapy.

The longer survival came with a price. Early in the treatment, women getting the abdominal therapy had more gastrointestinal, nerve, and heart problems than the other patients did. Many of the women getting abdominal therapy also had complications and discomfort associated with their catheters. Only 42 percent of them completed all six planned abdominal-chemotherapy treatments, says study coauthor Robert A. Burger, a gynecologic oncologist at the University of California, Irvine.

But after 1 year, surviving patients in both groups reported similar qualities of life.

The National Cancer Institute and several professional societies now recommend that this regimen be offered to women with stage III ovarian cancer. “Since most oncologists have not administered [abdominal] chemotherapy,” Burger says. “We need to train people how to do this safely and effectively.”