Abstract
In order to break through drug resistance in platinum-refractory ovarian cancer, augmented drug exposure was administered to the abdomen by means of an isolated perfusion system. Four cycles of isolated hypoxic abdominal perfusion with cisplatin, adriamycin, and mitomycin were conducted in 4-week intervals. Cisplatin and adriamycin were chosen because of their increased cytotoxicity under hypoxic conditions. Chemofiltration was performed for prophylaxis of cumulative toxicity of adriamycin and mitomycin. The study included 45 patients with recurrent epithelial ovarian cancer who had prior platinum containing therapies (3, stage Federation of Gynecology and Obstetrics (FIGO) IIIB; 20, stage FIGO IIIC; 22; stage FIGO IV). The median survival rate in stage FIGO IIIBC was 12 months, and in stage IV was 10 months. The tumor marker decreased to complete response or partial response at 17.8% and 55.6% of the patients. CT or MRI visualization showed complete response in 4.1%, and partial response was in 54.1%. Complete resolution of ascites was noted in 30% of cases and substantial reduction in another 43%. Toxicity was generally low. Quality of life was improved in the majority of cases. Bone-marrow suppression ranged between WHO grade 1 and 2, and in patients with previous third- or fourth-line chemotherapy, it was WHO grade 3. Isolated hypoxic abdominal perfusion with chemofiltration for patients with progressive and platinum-refractory stage III and IV ovarian cancer is an effective therapy, breaking through chemoresistance and offering comparably long survival at good quality of life.
Highlights
Ovarian cancer is the leading cause of death among all gynecological cancers
Time measurements started after completing multiple lines of standard chemotherapy, diagnosis of recurrent or progressive disease, and start treatment with hypoxic abdominal perfusion therapy
According to tumor marker 12-5, complete response and partial response have been achieved in 17.8% and 55.6% of all patients, respectively
Summary
Ovarian cancer is the leading cause of death among all gynecological cancers. The standard therapy option is still complete cytoreduction when possible, combined with chemotherapy [1,2,3]. The shorter the recurrence-free interval, the lower the prospect of a renewed response to chemotherapy [4,5,6]. While increased drug exposure could theoretically lead to a renewed response, they are not universally administered due to increased toxicity [7,8,9,10,11,12,13,14,15]. Even high-dose or modified combination therapy did not result in any real progress [16,17,18,19]. Recently two randomized studies showed that the addition of HIPEC to cytoreductive surgery resulted in longer recurrence-free and overall survival than cytoreductive surgery alone [20, 21]
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