SGO focus: IP therapy has long-term benefit in ovarian cancer

A meta-analysis of two Gynecologic Oncology Group (GOG) clinical trials shows a clear long-term survival benefit for intraperitoneal (IP) therapy over intravenous (IV) treatment of ovarian cancer. The results were presented at the 2013 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer in Los Angeles.

The findings, based on data from GOG clinical trials 114 and 172, represented outcomes in 876 women with advanced ovarian cancer. GOG-114 randomized patients with optimally resected stage III ovarian cancer to IV cisplatin/paclitaxel or to IV carboplatin followed by IP cisplatin/paclitaxel. In COG-172, women with resected stage III ovarian cancer were randomized to therapy with IV paclitaxel followed by either IV cisplatin or IP cisplatin and IP paclitaxel.

The new analysis showed a benefit of IP over IV therapy that extended beyond 10 years, with median survival time for both trials at 10.7 years. Median survival was 61.8 months for IP therapy, versus 51.4 months for IV treatment (P=0.048). IP therapy was associated with a 17% decrease in risk of death (adjusted hazard ratio [AHR]=0.83, 85% CI, 0.71-0.97; P=0.02). Younger age, better performance status, non-clear cell/mucinous histology, low-grade histology, and microscopic disease all were predictive of improved survival after IP therapy.

IP therapy’s survival advantage was evident in women with both microscopic (IP vs IV: 65% vs 58%) and gross residual disease (IP vs IV: 44% vs 35%). The 5-year survival rate was 59% in those who completed 5 or 6 cycles of IP therapy, compared to 18% vs 33% with 1 or 2 vs 3 or 4 cycles, respectively (P<0.001). Younger patients and women with microscopic residual disease were more likely to complete 6 cycles.