Medline ® Abstract for Reference 37
of 'First-line chemotherapy for advanced (stage III or IV) epithelial ovarian, fallopian tubal, and peritoneal cancer'
Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study.
Tewari D, Java JJ, Salani R, Armstrong DK, Markman M, Herzog T, Monk BJ, Chan JK
J Clin Oncol. 2015 May;33(13):1460-6. Epub 2015 Mar 23.
PURPOSE: To determine long-term survival and associated prognostic factors after intraperitoneal (IP) chemotherapy in patients with advanced ovarian cancer.
PATIENTS AND METHODS: Data from Gynecologic Oncology Group protocols 114 and 172 were retrospectively analyzed. Cox proportional hazards regression models were used for statistical analyses.
RESULTS: In 876 patients, median follow-up was 10.7years. Median survival with IP therapy was 61.8 months (95% CI, 55.5 to 69.5), compared with 51.4 months (95% CI, 46.0 to 58.2) for intravenous therapy. IP therapy was associated with a 23% decreased risk of death (adjusted hazard ratio [AHR], 0.77; 95% CI, 0.65 to 0.90; P = .002). IP therapy improved survival of those with gross residual (≤1 cm) disease (AHR, 0.75; 95% CI, 0.62 to 0.92; P = .006). Risk of death decreased by 12% for each cycle of IP chemotherapy completed (AHR, 0.88; 95% CI, 0.83 to 0.94; P<.001). Factors associated with poorer survival included: clear/mucinous versus serous histology (AHR, 2.79; 95% CI, 1.83 to 4.24; P<.001), gross residual versus no visible disease (AHR, 1.89; 95% CI, 1.48 to 2.43; P<.001), and fewer versus more cycles of IP chemotherapy (AHR, 0.88; 95% CI, 0.83 to 0.94; P<.001). Younger patients were more likely to complete the IP regimen, with a 5% decrease in probability of completion with each year of age (odds ratio, 0.95; 95% CI, 0.93 to 0.96; P<.001).
CONCLUSION: The advantage of IP over intravenous chemotherapy extends beyond 10 years. IP therapy enhanced survival of those with gross residual disease. Survival improved with increasing number of IP cycles.
Devansu Tewari, Kaiser Permanente Irvine Medical Center, Irvine; John K. Chan, California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA; James J. Java, Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Ritu Salani, Wexner Medical Center, Ohio State University, Columbus; Thomas Herzog, University of Cincinnati, Cincinnati, OH; Deborah K. Armstrong, Sidney Kimmel Comprehensive Cancer Center, John Hopkins University School of Medicine, Baltimore, MD; Maurie Markman, Eastern Regional Medical Center, Cancer Treatment Centers of America, Philadelphia, PA; Bradley J. Monk, Creighton University School of Medicine, Phoenix, AZ.