Pumping heavy doses of chemotherapy drugs right into the abdomen boosted survival of women with advanced ovarian cancer by 16 months in what experts call the first big advance in more than a decade against one of the most lethal cancers in women.
There's a high price, though: The treatment is so tough that nearly six in 10 women in a study could not endure it and switched to standard intravenous chemotherapy. Side effects included abdominal pain from bloating and problems with the catheter used to infuse the drugs.
Still, the US' National Cancer Institute is urging doctors to begin using the procedure, its first endorsement of any cancer treatment since 1999. Six medical groups focused on ovarian cancer joined in the recommendation.
The study was reported in yesterday's New England Journal of Medicine.
Steven Cannistra of Harvard Medical School wrote in an editorial that the 16 month jump in survival "is one of the largest benefits ever observed" from a therapy for gynecologic cancer.
About 80 percent of women are diagnosed after ovarian cancer has spread because early symptoms are so mild. It is the top killer among gynecologic cancers in the US. Last year, about 22,200 American women were diagnosed and about 16,200 died from it, according to the cancer institute. Fewer than half its victims survive five years after diagnosis.
To improve on that, doctors at dozens of US hospitals, led by Deborah Armstrong at Johns Hopkins Kimmel Cancer Center, compared chemo regimens in 415 women. Each had surgery to remove ovarian tumors, but some hard-to-reach cancer cells remain in the abdominal cavity. It's tough for IV chemo drugs to reach those cells and there's a limit to how high a dose can be given through the bloodstream.
Half the women in the study got standard intravenous chemotherapy with Taxol and cisplatin. The others got IV Taxol, then abdominal infusions of cisplatin and more Taxol at high doses.
The drugs were given through an implanted seal with a catheter, or tiny tube, hanging down into the abdominal cavity. The women rolled back and forth to bathe all the cancer cells in the mixture.
Median survival was about four years and two months for women who received only IV chemotherapy, but was just over five-and-a-half years for women who also got at least some of the abdominal chemotherapy.
But only 42 percent could tolerate all six cycles of abdominal chemotherapy.
"It's not perfect, but it is certainly a major improvement in outcome," the biggest in ovarian cancer since Taxol was introduced nearly 15 years ago, said Richard Barakat, the head of gynecologic oncology at Memorial Sloan-Kettering Cancer Center.
Barakat was not involved in the study, but based on its results is offering the treatment as standard care. He said 70 percent of patients last through the treatment, "but it's not a walk in the park," with some women faring poorly and others unsuited to it.
Armstrong, associate professor of oncology, gynecology and obstetrics at Johns Hopkins, said she believes her results can be improved, and new studies are trying different chemo drugs, dose schedules and catheter types.
American Cancer Society president Carolyn Runowicz said blockages and other catheter problems can be resolved and that more advances would follow.