Intraperitoneal Chemotherapy for Ovarian Cancer: Is It A New Standard Or Not?

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Intraperitoneal Chemotherapy for Ovarian Cancer: Is It A New Standard Or Not?
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Some two years after the big lay press splash about intraperitoneal chemotherapy being superior for primary ovarian cancer treatment, a robust debate rages on. Researchers in Belgium recently reviewed the medical literature on intraperitoneal chemotherapy and published their findings in the April 2008 issue of the "Oncologist". This should serve as a timely blog post to make everyone aware of the ongoing issues.

It is important to note that while the lay press stories seemed overwhelmingly positive in their reporting and conclusions, the medical studies that led to these stories had some interesting twists that were not in the public's eye. Perhaps it was too early to declare a new gold standard.

It was clear from the beginning that intraperitoneal chemotherapy is associated with a higher toxicity and complication risk than seen with intravenous chemotherapy. That was reported, but was somewhat under-emphasized because of the supposed major survival improvement. However, in reality, the most recent studies were comparing a number of questions (not just intravenous versus intraperitoneal chemo) and the intravenous chemotherapy drugs that were used in the most recent study were not even the current standard. Rather, they were part of the older standard. Furthermore, not all measures of survival advantage were significant, statistically speaking. So, the advantages may not have been as great as it all seemed.

Due to the high side-effect potential and unclear degree of survival improvement, many experts feel that intraperitoneal chemotherapy should still be considered experimental. Vergote and colleagues suggested that clinical trials should either evaluate intraperitoneal chemotherapy in comparison with the current standard intravenous treatment, or they should investigate the exact same drugs given intravenously and intraperitoneally after adjusting for dose requirement differences. In other words, the two issues should not be mixed up as they were in prior trials. They also suggested that we should be looking for less toxic drug combinations, preferably those which can be combined with molecular targeted therapies that are the subject of exciting new scientific advances.

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