Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. May 24, 2019; 10(5): 201-212
Published online May 24, 2019. doi: 10.5306/wjco.v10.i5.201
Clinical benefit and tolerability of adjuvant intraperitoneal chemotherapy in patients who have or have not received neoadjuvant chemotherapy for advanced ovarian cancer
Trishala Meghal, Vishangi Dave, Horace Tang, Vivek Kumar, Yiqing Xu
Trishala Meghal, Vishangi Dave, Yiqing Xu, Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY 11219, United States
Horace Tang, Queens Hospital Center, Jamaica, NY 11418, United States
Vivek Kumar, Department of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
Author contributions: Meghal T, Dave V, Tang H and Xu Y contributed to the data collection and data analysis; Kumar V contributed to the statistical analysis; Meghal T, Kumar V and Xu Y wrote the manuscript; and all the authors approved the manuscript.
Institutional review board statement: IRB approved study on 11/2/2015, and the study was reviewed and approved by IRB annually.
Informed consent statement: No consent required, it is a retrospective study.
Conflict-of-interest statement: No one has conflict of interest in relevance to this study.
Data sharing statement: De-identified data on the clinical characteristics, treatment, toxicity and outcomes can be shared with the editor upon request, and upon IRB approval.
STROBE statement: The study was conducted and the manuscript was prepared with the guidance of the STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yiqing Xu, MD, PhD, Associate Professor, SUNY Downstate College of Medicine, Division of Hematology and Oncology, Department of Internal Medicine, Maimonides Medical Center, 6300 8th Avenue, Brooklyn, NY 11220, United States. yxu@maimonidesmed.org
Telephone: +1-718-7652600 Fax: +1-718-7652630
Received: January 3, 2019
Peer-review started: January 4, 2019
First decision: January 26, 2019
Revised: March 12, 2019
Accepted: March 26, 2019
Article in press: March 27, 2019
Published online: May 24, 2019
Processing time: 141 Days and 8.5 Hours
Abstract
BACKGROUND

Adjuvant chemotherapy using intraperitoneal (IP) treatment has demonstrated survival benefit over intravenous (IV) therapy alone in patients treated with upfront debulking surgery for advanced stage ovarian cancer. Neoadjuvant chemotherapy followed by interim surgery and adjuvant chemotherapy has similar outcome in survival as compared to upfront surgery followed by adjuvant IV chemotherapy. IP chemotherapy has not been widely adopted in clinical practice for a number of reasons. Whether IP chemotherapy delivered in the patients who received neoadjuvant chemotherapy can be well tolerated or confers any clinical benefit has not been well studied.

AIM

To evaluate the experience of adjuvant IP chemotherapy in the community cancer clinic setting, and the clinical benefit and tolerability of incorporating IP chemotherapy in patients who received neoadjuvant treatment.

METHODS

We retrospectively evaluated toxicities and outcomes of patients with stage III and IV ovarian cancer diagnosed at our institution between 07/2007 and 07/2015 who received intraperitoneal chemotherapy after cytoreductive surgery (group 1) or after neoadjuvant chemotherapy followed by interim surgery (group 2).

RESULTS

Thirty eight patients were treated with IP chemotherapy, median age was 54 years old (range 38.6 to 71 years). In group 1 (n = 25), 12 (48%) of the patients completed 4 or more cycle of IP treatment after upfront debulking surgery; while in group 2 (n = 13), 8 (61.5%) of the patients completed all 3 cycles of the assigned IP chemotherapy after receiving neoadjuvant IV chemotherapy followed by surgery, and 2 (15.4%) more patients tolerated more than 3 cycles. In those patients who did not get planned IP chemotherapy, most of them were treated with substitutional IV chemotherapy, and the completion rate for 6 cycles of IV + IP was 92%. Abdominal pain, (64% in group 1 and 38% in group 2), vomiting, (36% in group 1 and 30.8% in group 2), dehydration (16% in group 1 and 15.4% in group 2), and hypomagnesemia (12% in group 1 and 15.4% in group 2) were the most common adverse effects in all patients, while patients who have received neoadjuvant chemotherapy were more likely to get hypokalemia, fatigue and renal insufficiency. Progression free survival (PFS) was 26.5 mo (95% CI 14.9, 38.0) in group 1 and 27.6 mo (95% CI 13.1, 42.1) in group 2. The overall survival was 100.2 mo (95% CI 67.9, 132.5) for group 1 and 68.2 mo (95% CI 32.2, 104.0) for group 2. For the entire cohort, PFS was 26.5 mo (95% CI 15.9, 37.0) and OS was 78.8 mo (95% CI 52.3, 105.4).

CONCLUSION

The use of IP/IV chemotherapy can be safely administrated in the community cancer clinic setting. The use of IP/IV chemotherapy in patients who have received neoadjuvant chemotherapy followed by surgery is feasible and tolerable. Despite various modification of the IP regimen, incorporation of IP chemotherapy in the adjuvant setting appears to be associated with improved PFS and overall survival.

Keywords: : Ovarian cancer; Intraperitoneal chemotherapy; Community setting; Safety; Tolerability; Outcome

Core tip: Intraperitoneal chemotherapy has shown survival benefits in the adjuvant setting among the patients with advanced stage ovarian carcinoma undergoing debunking surgery. However, this intraperitoneal route could not be widely adopted due to a number of issues including patients choice and its cumbersome nature. The present study explores its feasibility in a community cancer setting. We have retrospectively analyzed the rates of toxicities and outcome of the patients who received this therapy in our cancer center. We conclude that intraperitoneal chemotherapy can be safely administered in the community cancer setting and improves the overall and progression free survival.