A New Old Therapy

Investigators have found that injecting standard chemotherapy into the abdominal cavity—instead of intravenously alone—increases survival with advanced ovarian cancer by, on average, a remarkable 16 months.

What did the experiment test, and how credible are the results? The study, published last week in the New England Journal of Medicine, was a rigorous trial of 429 women who had Stage 3 ovarian cancer and were randomly assigned to receive chemotherapy either intravenously or through both the bloodstream and the abdomen (via a catheter).

What was the treatment like? Patients first underwent surgery to clear the abdominal area—including around the liver, spleen and under the diaphragm—of as much cancer as possible, followed by 18 weeks of chemo.

Why does where you give the chemotherapy make such a difference? Ovarian cancer is unusual in that it often spreads throughout the abdomen but not into the lymph nodes, so it is possible to focus treatment on just one part of the body.

How toxic are the drugs? Patients in both groups lost their hair and were at risk of developing fatal infections as well as nerve and kidney damage. The intra-abdominal-therapy patients became sicker midway through treatment and felt worse for as long as a year afterward. But even those who could tolerate the therapy for only a short time derived some benefit.

Is this the cure for ovarian cancer? No. As of November, more than 200 study participants had suffered a recurrence of their cancer and died. But the median survival rate was better than five years for the group that received intravenous and intra-abdominal chemotherapy, compared with a little more than four years for the intravenous-only group. That's a big gain when you realize success in cancer studies is usually measured in months, not years.