Dr. Berger on Chemotherapy Delivery Options in Ovarian Cancer

Jessica Layne Berger, MD, gynecologic oncologist, University of Pittsburgh Medical Center Hillman Cancer Center, discusses chemotherapy delivery options for patients with ovarian cancer.

Historically, intraperitoneal (IP) chemotherapy was thought to increase the treatment effects because it could be delivered directly into the abdominal cavity where the tumors are located, explains Berger. Multiple clinical trials demonstrated improved survival with IP chemotherapy, despite increased toxicity.

For example, the phase III GOG-172 trial showed a survival benefit with intravenous (IV) paclitaxel plus IP cisplatin and paclitaxel versus IV paclitaxel and cisplatin in women with optimally debulked stage III ovarian cancer. However, only 42% of patients in the IP chemotherapy arm were able to complete 6 cycles of therapy.

Dose reductions and increased supportive care allowed more patients to complete the full course of treatment, but it remains a difficult regimen to give, says Berger.

Conversely, the phase III GOG-262 study showed that weekly dose-dense paclitaxel plus carboplatin did not prolong survival compared with carboplatin and paclitaxel, which was given every 3 weeks. However, 84% of patients opted to receive concurrent bevacizumab (Avastin), which may have contributed to the negative results, explains Berger.

As such, deciding between IV, IP, and dose-dense chemotherapy often comes down to personal preference, concludes Berger.