Intra-Peritoneal Cisplatin Combined with Intravenous Paclitaxel in Optimally Debulked Stage 3 Ovarian Cancer Patients: An Izmir Oncology Group Study

Background: The advantage of intra-peritoneal (IP) chemotherapy (CT) in the initial management of ovarian cancer after cytoreductive surgery is well known. The feasibility and toxicity of a treatment regimen with an IP + intravenous CT (IPIVCT) for optimally debulked stage III ovarian cancer were here evaluated retrospectively. Materials and Methods: A total of 30 patients were treated in our institution between October 2006 and February 2011. Patients received IV paclitaxel $175mg/m^2$ over 3 hours followed by IP cisplatin $75mg/m^2$ on day 1; they also received IP paclitaxel $60mg/m^2$ on day 8. They were also scheduled to receive 6 courses of CT every 21 days. Results: The median age of the patients was 55 years (35-77), and the majority had papillary serous ovarian cancer (63.3%). The patients completed a total of 146 cycles of IPIVCT. Twenty-eight were able to receive at least three cycles of IPIVCT and 18 (60%) completed the scheduled 6 cycles. Two patients discontinued the IPIVCT because of toxicity of chemotherapy agents and 6 had to stop treatment due to intolerable abdominal pain during IP drug administration, obstruction and impaired access. Grade 3/4 toxicities included neutropenia (6 patients; 20%), anemia (2 patients; 6.7%) and nausea-vomiting (2 patients; 6.7%). Doses were delayed in 12 cycles (8%) for neutropenia (n=6), thrombocytopenia (n=3) and elevated creatinine (n=3). Drug doses were not reduced. The median duration of progression-free survival (PFS) was 47.7 months (95%CI, 38.98-56.44) and overall survival (OS) was 51.7 months (95%CI, 44.13-59.29). Two and five-year overall survival rates were 75.6 % and 64.8%, respectively. Conclusions: IPIVCT is feasible and well-tolerated in this setting. Its clinically proven advantages should be taken into consideration and more efforts should be made to administer IPIVCT to suitable patients.