The CancerWeb Report, What's New In Cancer: January, 1997
Ovarian Cancer

• Intraperitoneal cisplatin improves outcome in advanced (Stage III) ovarian cancer - As compared with using intravenous cisplatin in combination with cyclophosphamide, the administration of cisplatin directly into the abdomen - intraperitoneal administration - significantly improves survival and has fewer side-effects than intravenous cisplatin in women with advanced (Stage III) ovarian cancer. This was the finding of a cooperative trial carried out at a number of medical institutions throughout the US, and reported in the December 26, 1996 issue of the New England Journal of Medicine. This study involved a total of 546 patients, and median survival was calculated as 49 months in the group who received intraperitoneal cisplatin, an eight-month increase compared to the intravenous-therapy group. (Alberts, New Engl J Med 335:1950, 1996)

  Editor's Comment: - Ovarian cancer tends to seed small tumors around the abdominal cavity, so that intraperitoneal treatment is a logical course of action, earlier examples being the use of radioactive gold colloid suspensions and alkylating agents. Wide-bore needles are needed to penetrate the thick abdominal wall, and there are risks of severely irritating the lining of the cavity, introducing infections, and penetrating the intestine with risk of releasing intestinal contents and producing peritonitis. In addition, prolonged infusions are desirable to extend exposure of tumor to drugs, but are not feasible with the usual fluids used for intraperitoneal dialysis. For these reasons, intraperitoneal administration has not been widely used. There is renewed interest in this approach, however. For example, a report in the December issue of the British Journal of Cancer describes the use of a new carrier solution called Icodextrin 20, which was used by the researchers in the UK at 7.5% concentration to administer 5-fluorouracil successfully to patients with colorectal, stomach and ovarian cancers (Kerr, Br J Cancer 74:2032, 1996).

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• Peripheral blood stem cells permit increased intensity of chemotherapy dosing in ovarian cancer patients - Researchers at the Christie Hospital, Manchester, UK, described the mobilization of blood stem cells with filgrastim with or without cyclophosphamide, in an article in the December, 1996 issue of the British Journal of Cancer. Administration of the mobilized stem cells plus filgrastim permitted a doubling of the dose intensity of a carboplatin (AUC 7.5) and cyclophosphamide (900 mg/m2) regimen as compared to the standard treatment used. (Weaver, Br J Cancer 74:1821, 1996)