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Wright AA , Cronin A , Milne DE , Bookman MA , Burger RA , Cohn DE , Cristea MC , Griggs JJ , Keating NL , Levenback CF , Mantia-Smaldone G , Matulonis UA , Meyer LA , Niland JC , Weeks JC , O'Malley DM
Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer
J Clin Oncol. 2015 Sep 10;33(26) :2841-7
PMID: 26240233 URL: http://www.ncbi.nlm.nih.gov/pubmed/26240233
AbstractPURPOSE: A 2006 randomized trial demonstrated a 16-month survival benefit with intraperitoneal and intravenous (IP/IV) chemotherapy administered to patients who had ovarian cancer, compared with IV chemotherapy alone, but more treatment-related toxicities. The objective of this study was to examine the use and effectiveness of IP/IV chemotherapy in clinical practice. PATIENTS AND METHODS: Prospective cohort study of 823 women with stage III, optimally cytoreduced ovarian cancer diagnosed at six National Comprehensive Cancer Network institutions. We examined IP/IV chemotherapy use in all patients diagnosed between 2003 and 2012 (N = 823), and overall survival and treatment-related toxicities with Cox regression and logistic regression, respectively, in a propensity score-matched sample (n = 402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias. RESULTS: Use of IP/IV chemotherapy increased from 0% to 33% between 2003 and 2006, increased to 50% from 2007 to 2008, and plateaued thereafter. Between 2006 and 2012, adoption of IP/IV chemotherapy varied by institution from 4% to 67% (P < .001) and 43% of patients received modified IP/IV regimens at treatment initiation. In the propensity score-matched sample, IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%; hazard ratio, 0.68; 95% CI, 0.47 to 0.99), compared with IV chemotherapy, but also more frequent alterations in chemotherapy delivery route (adjusted rates discontinuation or change, 20.4% v 10.0%; adjusted odds ratio, 2.83; 95% CI, 1.47 to 5.47). CONCLUSION: Although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.
NotesWright, Alexi A Cronin, Angel Milne, Dana E Bookman, Michael A Burger, Robert A Cohn, David E Cristea, Mihaela C Griggs, Jennifer J Keating, Nancy L Levenback, Charles F Mantia-Smaldone, Gina Matulonis, Ursula A Meyer, Larissa A Niland, Joyce C Weeks, Jane C O'Malley, David M eng 2015/08/05 06:00 J Clin Oncol. 2015 Sep 10;33(26):2841-7. doi: 10.1200/JCO.2015.61.4776. Epub 2015 Aug 3.