New Chemotherapy Regimen Offers Better Survival in Advanced Ovarian Cancer
The University of Miami Sylvester Comprehensive Cancer Center is now offering intraperitoneal chemotherapy to select patients with ovarian cancer, directing chemotherapy straight into the abdomen instead of throughout the body. A new study by the Gynecologic Oncology Group published in the New England Journal of Medicine shows that women receiving this therapy survived more than a year longer, on average, than their counterparts who received standard intravenous chemotherapy.
“We expect improved progression-free and overall survival,” said Nicholas Lambrou, M.D., associate professor in gynecologic oncology and associate director of the Comprehensive Treatment Unit at UM/Sylvester. “In the past with ovarian cancer the best that we could offer patients was access to a clinical trial that might benefit them, but we couldn’t be sure. That’s the nature of this disease. So to finally have something that seems to increase survival in ovarian cancer is very exciting.”
Ovarian cancer is expected to strike more than 22,000 women in the United States this year, according to the American Cancer Society. More than 16,000 women will die from the disease this year. Ovarian cancer is rarely detected before it has advanced because it doesn’t present obvious symptoms in its early stages. The signs that are sometimes presented by ovarian cancer – mild abdominal pain, bloating, fatigue – are almost always something other than cancer, and these symptoms aren’t always present when there is cancer. All of the women in the clinical trial, which UM/Sylvester did not participate in, had advanced stage III disease.
Now, newly diagnosed ovarian cancer patients at UM/Sylvester who have successful surgery to remove the cancer will be eligible for this therapy. “The first step is to have the appropriate initial surgery, which means a thorough staging with complete removal of any visible disease,” says Joseph A. Lucci, III, M.D., director of Gynecologic Oncology at UM/Sylvester. The intraperitoneal catheter can be placed at the time of initial surgery or shortly thereafter. In the clinical trial, side effects of the chemotherapy, including serious abdominal pain, were worse in the women who opted for intraperitoneal (IP) chemo than in patients who received traditional intravenous chemo. IP chemo patients were also more likely to report fatigue, gastrointestinal problems and problems with their metabolism, and only 42 percent of IP patients in the clinical trial completed all six cycles of IP chemo. But even those who did not complete IP chemo went five months longer without a recurrence and survived an average of 16 months longer than patients treated with standard IV chemo, and IP chemo patients interviewed one year after treatment reported no lasting side effects.
Lambrou and his colleagues at UM/Sylvester have invited a chemotherapy nursing specialist from Johns Hopkins University who was part of the initial trial to educate and train the UM/Sylvester team of nurses. “We feel that intraperitoneal chemotherapy is most safely given in a setting with highly trained and specialized nurses such as we have here at UM/Sylvester,” said Lambrou. “With the appropriate training and with a novel approach that we’ve adopted here, we also believe we can minimize the side effects.”
UM/Sylvester is among the first centers to offer this therapy in South Florida and has been active in adopting what is considered the new standard of care. UM/Sylvester also offers on-site screening and guidance with a certified genetic counselor and is currently offering more than two dozen clinical trials in gynecologic oncology.
“With ovarian cancer there are very important things that patients should keep in mind,” said Lambrou. “Number one is to have the best possible surgery the first time around, meaning to get as much disease out as possible. Studies show this happens better at academic medical centers with trained gyn oncologists.” Patients who opt for IP chemo also benefit from what is called a “second look” surgery. When surgeons operate to remove the catheter from under the skin of the abdomen, six months after the first surgery, they can inspect the abdominal cavity for signs of cancer and literally see how well the chemotherapy worked. “In one case I did a second look surgery on an 18-year-old who wanted it and we found microscopic disease that didn’t appear on CT or PET scan,” said Lambrou. “So for her it was very informative.”
For more information on the GOG study, see the article in the January 5, 2006, issue of the New England Journal of Medicine, http://content.nejm.org/cgi/content/abstract/354/1/34. To learn more about IP chemotherapy in South Florida call UM/Sylvester at (305) 243-1000.
UM/Sylvester opened in 1992 to provide comprehensive cancer services and today serves as the hub for cancer-related research, diagnosis, and treatment at the University of Miami Leonard M. Miller School of Medicine. UM/Sylvester handles 1,400 inpatient admissions annually, performs 3,000 surgical procedures, and treats 3,000 new cancer patients. All UM/Sylvester physicians are on the faculty of the Miller School of Medicine, South Florida’s only academic medical center. In addition, UM/Sylvester physicians and scientists are engaged in 200 clinical trials and receive more than $31 million annually in research grants. UM/Sylvester at Deerfield Beach recently opened to better meet the needs of residents of Broward and Palm Beach Counties. This 10,000-square-foot facility at I-95 and S.W. 10th Street offers appointments with physicians from six cancer specialties, complementary therapies from the Courtelis Center, and education and outreach events.