TY - JOUR
T1 - Use and effectiveness of intraperitoneal chemotherapy for treatment of ovarian cancer
AU - Wright, Alexi A.
AU - Cronin, Angel
AU - Milne, Dana E.
AU - Bookman, Michael A.
AU - Burger, Robert A.
AU - Cohn, David E.
AU - Cristea, Mihaela C.
AU - Griggs, Jennifer J.
AU - Keating, Nancy L.
AU - Levenback, Charles F.
AU - Mantia-Smaldone, Gina
AU - Matulonis, Ursula A.
AU - Meyer, Larissa A.
AU - Niland, Joyce C.
AU - Weeks, Jane C.
AU - O'Malley, David M.
N1 - Publisher Copyright:
© 2015 American Society of Clinical Oncology. All rights reserved.
PY - 2015/8/10
Y1 - 2015/8/10
N2 - Purpose: 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.
AB - Purpose: 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.
KW - Adolescent
KW - Adult
KW - Aged
KW - Antineoplastic Agents/administration & dosage
KW - Cohort Studies
KW - Female
KW - Humans
KW - Infusions, Intravenous
KW - Injections, Intraperitoneal
KW - Middle Aged
KW - Ovarian Neoplasms/drug therapy
KW - Proportional Hazards Models
KW - Prospective Studies
UR - http://www.scopus.com/inward/record.url?scp=84954340090&partnerID=8YFLogxK
U2 - 10.1200/JCO.2015.61.4776
DO - 10.1200/JCO.2015.61.4776
M3 - Article
C2 - 26240233
AN - SCOPUS:84954340090
SN - 0732-183X
VL - 33
SP - 2841
EP - 2847
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 26
ER -