Better Ovarian Cancer Outcome With IP Cisplatin

LOS ANGELES--Administration of cisplatin (Platinol) by the intraperitonealrather than intravenous route to patients with optimally debulkedstage III ovarian cancer reduced toxicity and improved survivalby about 25%, David S. Alberts, MD, said at the ASCO meeting.

In this Intergroup study of 544 patients, the largest prospectivephase III trial ever performed in ovarian cancer, median survivalafter more than 50 months of follow-up was 51 months on the IParm vs 41 months on the IV therapy arm, a significant difference.

The IP to IV death hazard ratio was .75. "Thus, at any timeduring this study and its follow-up, there was a 25% greater likelihoodof being alive if the patient was treated with IP therapy,"said Dr. Alberts, deputy director, Arizona Cancer Center, Tucson.There were 171 deaths on the IV arm vs 143 on the IP arm.

Patients in the study had less than 2 cm residual tumor afterprimary surgery (more than 70% had less than 0.5 cm) and werestratified according to degree of residual disease and performancestatus before randomization.

They then received cisplatin, 100 mg/m², either IV or IP(in 2 liters of saline), plus IV cyclophosphamide, 600 mg/m²,every 3 weeks for six cycles.

Patients on IP therapy had significantly less grade 3 or 4 neutropenia,which was not unexpected, since the peak plasma level of the drugis dramatically reduced with IP delivery. More IP patients hadabdominal pain, but this was well controlled with narcotics.

The IP patients also had a significantly lower incidence of tinnitusand clinical hearing loss (5% clinical hearing loss of grade 2or greater vs 14% on the IV arm).