Lay Summary: IP Chemotherapy is now standard for ovarian cancer.
The recommended treatment for ovarian cancer entails primary surgery for diagnosis, staging and cytoreduction (the removal of cancerous mass), followed by chemotherapy. Recommended initial chemotherapy is generally a platinum-and-taxane chemotherapy combination.Intravenous (IV) administration of chemotherapy drugs is done by inserting a needle into a vein in the body of a patient whereas intraperitoneal (IP) administration of chemotherapy is done through a surgically implanted catheter that allows passage of fluids into the abdomen of a woman.
According to a study published in the New England Journal of Medicine, patients who received part of their chemotherapy via an IP route had a median survival time of 16 months longer than women who received IV chemotherapy. Certain chemotherapy drugs, such as cisplastin and paclitaxel have been found to have distinct advantages when given via the IP route. These advantages include higher drug concentrations and longer drug half lives (meaning the drug will remain active for a longer period of time) in the peritoneal cavity. It does require inpateint stays, although homecare companies are beginning to provide this service at home. It is, however, not universally available or adopted because it is cumbersome. Where paclitaxel cannot be used, cytoxan is a easonable alternative, supported by phase II studies as well as phase III comparative studies of IV cytoxan/cisplatin versus paclitaxel/ cisplatin.
Elit L, Oliver TK, Covens A, et al. Intraperitoneal chemotherapy in the first-line treatment of women with Stage III epithelial ovarian cancer: a systematic review with meta-analysis. Cancer. 2007;109:692-702.
Armstrong D, Bundy B, Wenzel L, et al. Intraperitoneal Cisplatin and Paclitaxel in Ovarian Cancer. New England Journal of Medicine. 2005; 354:34-43
Maurie Markman, MD Second-line chemotherapy for refractory cancer: Intraperitoneal chemotherapy Seminars in Surgical Oncology Volume 10, Issue 4 , Pages 299 – 304, 2006