HIPEC Improves Ovarian Cancer Survival
KRISTIE L . KAHL
Wednesday , February 28 , 2018
Women with stage 3 epithelial ovarian cancer could benefit from the addition of hyperthermic intraperitoneal chemotherapy ( HIPEC ) , also known as a hot chemotherapy bath . Study results published in the New England Journal of Medicine showed that HIPEC improved survival rates by 10% .
Patients with newly diagnosed advanced-stage ovarian cancer are often treated with cytoreductive surgery and systemic chemotherapy . Patients either start with an operation followed by 6 courses of chemotherapy , or primary debulking , or they are given 3 courses of chemotherapy before surgery and 3 more courses after , also known as interval debulking .
With these treatment options , only one-third of patients are still alive after 5 years , according to a Netherlands Cancer Institute press release .
Therefore , researchers in the Netherlands investigated whether the addition of HIPEC to interval debulking would improve outcomes among patients who were receiving neoadjuvant chemotherapy as treatment for stage 3 epithelial ovarian cancer .
“ Ten years ago , we wanted to find out what the effect was of HIPEC for patients with ovarian carcinoma , ” lead author Willemien J . van Driel , MD , PhD , from the Department of Gynecology at the Netherlands Cancer Institute in Amsterdam , said in an interview with Oncology Nursing News . “ We had the results of the colon HIPEC trial which were positive , and we had the results of the Armstrong trial who showed a longer survival for patients receiving postoperative intraperitoneal chemotherapy . ”
In a multicenter , open-label , phase 3 trial , the researchers randomly assigned 245 patients to undergo interval debulking either with or without administration of HIPEC with cisplatin . Three additional cycles of carboplatin and paclitaxel were administered postoperatively .
The researchers specifically looked at recurrence-free survival , as well as overall survival ( OS ) and safety .
Events of disease recurrence or death occurred in 110 of the 123 patients who underwent surgery without HIPEC and in 99 of the 122 patients who had surgery plus HIPEC .
Patients treated with hot chemotherapy bath experienced longer recurrence-free survival ( 14 . 2 months ) compared with patients who did not ( 10.7 months ) .
After a follow-up of 4 . 7 years , 76 patients in the control arm ( 62% ) and 61 patients who received HIPEC ( 50% ) died . The group of patients who receive d hot chemotherapy bath also experienced longer OS compared with the control arm ( 45 . 7 months vs . 33 . 9 months ) .
“ Adding HIPEC to interval debulking improved both recurrence free survival and overall survival without increasing morbidity , ” said van Driel .
There was no difference in adverse events ( AEs ) among groups , and HIPEC appeared well-tolerated .
As a result of the study , the guidelines committee for gynecological oncology in the Netherlands will be discussing whether to add HIPEC as a standard of care . However , van Driel noted oncology staff will need to be trained because this is a complicated procedure .
“ In the Netherlands we are in the process of adjusting the guidelines at this point , ” she added . “ Once the literature search supports the result of the trial we will want to implement it as standard of care . It will be difficult to repeat this trial with this number of patients and the results are convincing . ”
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