G08 - Feasibility and Tolerability of Intraperitoneal Chemotherapy in Ovarian Cancer

Abstract

Background: Intraperitoneal chemotherapy (IPC) has shown to prolong OS in optimally debulked stage III ovarian cancer patients. A recent long-term survival update of GOG 114 and GOG 172 trials showed a median overall survival of 61,8 months with IPC compared with 51,4 months for intravenous (IV) chemotherapy with a reduction in the risk of death of 23%. Despite these positive results, IPC has not been widely accepted as standard of care. The hesitancy of clinicians to use IPC is mainly due to higher toxicity, permanent catheter complications, complex management of patients and, eventually, poor patients and health care providers' compliance. Aim of our study is to evaluate, in a recent real life setting, feasibility and tolerability of IPC administered with direct peritoneal puncture without permanent devices in ovarian cancer patients. Material and Methods: we collected patients (N = 8) treated at the Istituto Oncologico Veneto between November 2015 and April 2016. Eligibility criteria included stage III epithelial OC with residual disease < 1 cm after surgery and PS ≤2. Patients received IV paclitaxel 175 mg/mq and IP carboplatin AUC5 every 21 days. On the day of IPC, a Veress needle was placed in the peritoneum by an interventional radiologist under ultrasound scan control; the Veress needle was then removed at the end of each infusion. The procedure was performed at the bedside of the patient in the out patient clinic. Results: A total of 33 IP cycles have been administered: three patients have completed the planned six cycles; five patients have received 3 cycles and are still on treatment. No patients experienced G > 2 toxicities; most common adverse events were G2 anemia and neutropenia; three patients had treatment delays due to G2 afebrile neutropenia and subsequent cycles were administered at reduced doses; one patient with G2 anemia received IV iron supplementation. As far as catheter-related toxicity, one patient experienced a chemical cellulitis (due to a catheter leakage at the first infusion) that needed hospitalization for anti-inflammatory therapy and antibiotic prophylaxis. All other courses were administered without any complications. Conclusions: According to our experience, the direct intraperitoneal drug injection without permanent device appears to be feasible, safe and possibly advantageous because of minor toxicities when compared with historical series of IPC administrated by permanent catheter.