Historical progress in the initial management of ovarian cancer: intraperitoneal chemotherapy

Despite measured improvement in survival with the introduction of the platinates and taxanes in treatment of advanced ovarian cancer, little additional progress has been made with conventional cytotoxic agents. Recently, the Gynecologic Oncology Group (GOG) published data from a study evaluating the merits of intraperitoneal chemotherapy in women with advanced, optimally cytoreduced ovarian cancer. They documented a significant advantage in progression-free and overall survival for the experimental regimen, a combination of intravenous paclitaxel and intraperitoneal cisplatin and paclitaxel, compared with standard intravenous cisplatin and paclitaxel chemotherapy. The intraperitoneal regimen was substantially more toxic and was associated with reduced short-term quality of life. The GOG trial joins six other published phase III trials since 1994 comparing intravenous with intraperitoneal chemotherapy in advanced-stage epithelial ovarian cancer. A recent meta-analysis suggests a 21% reduction in the hazard for progression (four studies) and death (seven studies). Reluctance to adopt a new standard of care is rooted in toxicity concerns. Further evaluation is warranted to clarify unanswered questions regarding administration schedule, agents, techniques, number of courses, and patient eligibility for intraperitoneal chemotherapy.