Ovarian cancer: intraperitoneal chemotherapy ineffective in definitive trial

  • Walker JL & al.
  • J Clin Oncol
  • 19 Apr 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with newly diagnosed advanced ovarian carcinoma, intraperitoneal (IP) vs intravenous (IV) administration of chemotherapy fails to improve survival, increases toxicity.

Why this matters

  • This definitive trial suggests there is no longer any role of IP therapy.

Study design

  • 3-group, phase 3 Gynecologic Oncology Group (GOG)-252 study.
  • 1560 patients with newly diagnosed advanced ovarian carcinoma were randomly assigned to intravenous (IV) paclitaxel with either IV carboplatin or intraperitoneal (IP) carboplatin or IP cisplatin/paclitaxel.
  • All patients received bevacizumab.
  • Funding: National Cancer Institute.

Key results

  • Median follow-up, 84.8 months. 
  • Compared with the IV carboplatin group, median PFS was not significantly different in the IP carboplatin (24.9 vs 27.4 months; HR, 0.925; 95% CI, 0.802-1.07) or IP cisplatin (vs 26.2 months; HR, 0.977; 95% CI, 0.847-1.13) groups.
  • No difference in median PFS was observed in patients with stage II/III and residual disease of ≤1 cm and those with stage II/III and no residual disease.
  • Median OS was similar in the IV carboplatin vs IP carboplatin group (HR, 0.949; 95% CI, 0.799-1.128) and the IP cisplatin group (HR, 1.05; 95% CI, 0.884-1.24).
  • Grade ≥3 infections were more frequent (P=.008) in the IP groups.
  • The IP cisplatin group showed higher grade ≥3 hypertension (P<.005 and nausea rates>

Limitations

  • Open-label design.

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