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    New regimen recommended for treating advanced ovarian cancer

    March 23, 2015 (San Francisco, CA)

    A new approach to treating advanced ovarian cancer may significantly improve patients’ survival compared to standard chemotherapy regimens, according to results published online today as the featured article in the Journal of Clinical Oncology.

    In the study, researchers at California Pacific Medical Center (CPMC) and leading cancer centers across the U.S. provide 10-year data demonstrating long-term advantages over standard intravenous therapy, and suggesting new approaches to personalized treatments.

    Despite earlier research showing that chemotherapy administered through the abdominal lining (i.e., intraperitoneally, or IP) versus intravenously (IV) extends patients’ lives, clinicians have been hesitant to adopt the strategy as standard of care in advanced ovarian cancer. Some patients experience toxicity and treatment-related complications from IP therapy, and clinicians have been unclear on which patients will benefit most (or of how many IP cycles are required to confer treatment benefit while avoiding unnecessary toxicity).

    “Our results confirm prior reports but also suggest a long-term clinical benefit of IP therapy among patients with advanced disease,” said John Chan, MD, scientist and gynecologic oncologist at Sutter Health’s CPMC, Gynecologic Oncology Lead for Sutter West Bay Region, and lead study author. “With a multidisciplinary team of gynecologic oncologists, chemotherapy specialists, and palliative care providers, we are able to offer this specialized treatment at CPMC to most women, resulting in better care.”

    Most advanced ovarian cancers progress to the peritoneum (the thin layer of tissue lining the abdomen), where the primary tumor metastasizes and often causes fatal complications. Chemotherapy administered intraperitoneally gives continuous, prolonged exposure to the drug with less ‘seepage’ through the bloodstream compared with IV administration.

    In a retrospective analysis of two key Gynecologic Oncology Group phase III randomized clinical trials, Dr. Chan and colleagues at leading cancer centers across the U.S. investigated survival outcomes of 876 advanced ovarian cancer patients undergoing IP versus IV chemotherapy, and evaluated prognostic factors predicting treatment success.

    After an overall median follow-up of 10.7 years, IP therapy led to a 21% decreased risk of progression and a 23% decreased risk of death (p=0.002; 95% CI)—even after adjusting for age, performance status, cell type, tumor grade and residual disease. Median progression-free survival was 25 and 20 months in the IP and IV patient groups, respectively (p=0.019), with corresponding overall survival of 61.8 vs. 51.4 months, respectively (p=0.042). The risk of death decreased by 12% for each cycle of IP chemotherapy completed (p<0.001).

    Patients with serous carcinoma (versus clear-cell/mucinous) and no visible disease, and those who completed up to six cycles of therapy were more likely to benefit from IP treatment.
    “The long-term results of these trials are encouraging and show that survival endpoints can be achieved in advanced ovarian cancer,” said Dr. Chan. “Selecting patients who are more likely to complete IP therapy—thus predicting better outcomes and less toxicity associated with therapy—moves the field toward more individualized approaches to treating this cancer.”
    Epithelial ovarian cancer is the leading cause of gynecologic cancer, with over 20,000 patients diagnosed annually in the U.S.

    The study was supported by the National Cancer Institute with additional funds from the Gynecologic Oncology Group Young Investigator Award and the John A. Kerner Denise & Prentis Cobb Hale Research Award.