IP Chemotherapy Research Articles

Can carboplatin replace cisplatin for intraperitoneal use?

Intraperitoneal (IP) chemotherapy is theoretically a feasible route for treating ovarian cancer. It is possible to expose tumor tissue disseminated peritoneal surface to extremely high concentration of anticancer agents. Three large-scale, randomized trials conducted in the US have demonstrated a significant improvement of progression survival and/or overall survival in IP chemotherapy arm over intravenous arm. Despite these favorable results, IP chemotherapy has not been accepted as standard care. One of the reasons for this is the use of cisplatin, which has been replaced by the less toxic platinum agent, carboplatin, when administered intravenously. In this review article, we discuss why IP chemotherapy using carboplatin has been ignored and its future potential.

Endometrial stromal sarcoma associated with extrauterine endometriosis: a case report and literature review

Endometrial stromal sarcoma (ESS) that arises from extrauterine endometriosis is a rare form of malignancy. We report the case of a 37-year-old ESS patient with extrauterine endometriosis who was treated with ifosfamide/cisplatin chemotherapy. A woman presented with epigastric pain and abdominal distension. Computed tomography imaging revealed a profuse amount of ascites, including a 12.4×12.3 cm sized posterior cul-de-sac mass composed of solid and cystic components. Cytoreductive surgery was performed to remove the mass and the histopathologic findings indicated ESS associated with extrauterine endometriosis. Six cycles of combination chemotherapy [ifosfamide (5 g/m 2 ) with mesna (1 g/m 2 ) and cisplatin (50 mg/m 2 ) (IP)] were administered. After a six-month of disease-free interval, recurrent ESS developed in the pelvic cavity and in both lung fields. Megace medication decreased tumor marker CA-125 for six weeks. However, the patient expired sixteen months after the cytoreductive surgery. ESS associated with extrauterine endometriosis showed response to IP chemotherapy and megace.

A Comparison of Reimbursement for Outpatient Intraperitoneal (IP) Versus Intravenous (IV) Therapy for Ovarian Cancer

Objective. The GOG 172 trial produced compelling evidence demonstrating that IP chemotherapy produced superior outcomes to IV chemotherapy for women with advanced ovarian cancer (AOC). In January 2006 these results were published along with an NCI Clinical Alert documenting the improved overall survival resulting from IP treatment. However, broad adoption of IP chemotherapy may hinge in part on adequate reimbursement, thus requiring support from governmental and third party payors. This analysis is designed to compare reimbursement for outpatient IP versus IV chemotherapy within our marketplace, assuming that the net effect might affect overall adoption of this important new therapy.

Outpatient intraperitoneal chemotherapy for ovarian cancer chemotherapy—A comparison of reimbursement for intraperitoneal versus intravenous therapy

16027 Background: The GOG 172 trial produced compelling evidence that IP chemotherapy produced superior outcomes to IV chemotherapy for women with advanced ovarian cancer (AOC). In January 2006 these results were published along with an NCI Clinical Alert documenting the improved overall survival resulting from IP treatment. However, broad adoption of IP chemotherapy may hinge in part on adequate reimbursement, thus requiring support from governmental and third party payors. This analysis is designed to compare reimbursement for outpatient IP versus IV chemotherapy, assuming that the net effect might affect overall adoption of this important new therapy. Methods: A prospective trial of outpatient IP chemotherapy was initiated 1/2006 for women with AOC. A group of 28 AOC patients received 119 IP treatments between 1/2006 and 10/2006. Reimbursement for these treatments, net of related costs, was compared with that for standard IV chemotherapy. The IP regimen includes: aprepitant, palonosetron and dexamethasone on day 1; followed by docetaxel 70 mg/M2 then amifostine 910 mg/M2 (all IV) then cisplatin 100 mg/M2 IP; concluding with paclitaxel 60 mg/M2 IP on day 8. The IV regimen was carboplatin AUC 5 and taxane (paclitaxel 175 mg/M2 or docetaxel 70 mg/M2). The nursing administration codes for IP were 96445 on days 1 and 8; by comparison, the codes for IV were 96413 for infusions up to 1h, and 96415 for each additional hour. Data on precertification, total drug and administration charges, drug costs, and reimbursement were assimilated and used to compare reimbursement net of select costs. Results: Reimbursement for IP code 96445 was significantly higher than for IV codes 96413 and 96415, with the respective mean billed $2,469 for IP vs $834 for IV. Reimbursement rates for 96445 ranged from 25% to 100% (median 97%, mean 87%). Mean total charges for IP regimen was 1.28 times higher than for IV regimen, and reimbursement rates were comparable. Conclusions: IP chemotherapy for AOC is more effort intense and requires more chemotherapy drug and supportive care medications, resulting in higher charges and higher net revenue when administered on an outpatient basis. No significant financial relationships to disclose.

Intraperitoneal Chemotherapy in Ovarian Cancer Remains Experimental

Furthermore, more patients in the experimental arm (IP chemotherapy) were lost to follow-up, compared with those treated in the control arm (11v five patients). Such differences are not usually a concern. However, there were 127 and 101 patient deaths in the control and IP arms of the trial, respectively, and as few as three additional patient deaths in the IP arm could make the result nonsignificant. The statistical difference between the two arms of the trial is so marginal that these differences in eligiblity or loss of follow-up need to be investigated further. The absolute difference in patients alive (15 patients) was less than those patients lost to follow-up (16 patients; 11 in the IP arm), and this is a very small proportion of the total population. It must be questioned whether such toxic treatment should be introduced as

Combined IV and IP chemotherapy in ovarian cancer

Combined IV and IP chemotherapy in ovarian cancer

ADMINISTERING INTRAPERITONEAL CHEMOTHERAPY USING A PERITONEAL PORT

The IP access provided by the relatively closed system using subcutaneous portals linked to the Tenckhoff catheter has revolutionized the clinical approach to intra-abdominal tumors, especially to ovarian cancer. The development of totally implanted peritoneal access ports that diminish the risk of infection and the design of treatment regimens that do not require drainage of the drugs from the peritoneal cavity after instillation have reduced the technical complexity of IP therapy. This treatment approach is safe and can be easily administered by trained oncology nurses and physicians in an outpatient setting. The success of a program for IP chemotherapy depends on a reliable and safe access to the peritoneal cavity, such as the port. Because of the port, during the past 13 years IP chemotherapy has developed into an effective treatment, especially for ovarian cancer patients with small volume disease following laparotomy. Nurses have played a major role in the development of this treatment modality. They have become quite skillful in making assessments and intervening with appropriate nursing measures to ensure that a highly specialized and complex procedure is managed safely. Further clinical nursing research will improve the administration process of IP therapy and ultimately will improve the quality of life for patients.

Survival with Intraperitoneal Cisplatin in Advanced Ovarian Cancer after Second-Look Laparotomy

We studied survival in 36 patients with Stage III/IV ovarian cancer who received intraperitoneal high-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g), after intravenous (i.v.) cisplatin-based chemotherapy followed by second-look laparotomy. Complete responders were scheduled for three courses of IP chemotherapy, and others for six. Eight patients (22%) did not complete treatment (6 catheter failures and 2 renal failures). Peritoneal cytology remained positive in 6 patients (17%). Median overall and progression-free survival after second-look laparotomy were 44 and 37 months, respectively, for 13 complete responders to i.v. chemotherapy; 24 months and 11 months for patients with residual tumors less than 2 cm (17 cases); 15 and 12 months with tumors greater than 2 cm (6 cases). There was a significant difference in overall (p = 0.05) and progression-free (p = 0.001) survival between complete responders to i.v. chemotherapy and patients whose tumor was less than 2 cm. We find no evidence that high-dose cisplatin-based intraperitoneal chemotherapy given after second-look laparotomy will enhance survival in advanced ovarian cancer with zero or minimal residual disease.

Concepts in intraperitoneal chemotherapy.

NTRAPERITONEAL (IP) chemotherapy is the administration of chemotherapeutic agents via a catheter into the peritoneal cavity. The chemotherapy is placed in a large volume of fluid, usually 2 L, and infused into the abdominal cavity where it remains for a specified amount of time; then it is usually drained back out the catheter. The advantages of IP chemotherapy have been demonstrated in pharmacokinetic studies first done at the National Cancer Institute beginning in the 1970s.’ These and subsequent studies show that relatively higher concentrations of cancer chemotherapeutic drugs can be achieved with IP infusion as compared to plasma level concentrations following intravenous (IV) administration. I-3 IP chemotherapy can be particularly helpful in the treatment of ovarian cancer due to its propensity to metastasize via peritoneal seeding. High concentrations of chemotherapy in the peritoneal cavity then directly reach tumor tissue. IP chemotherapy has the greatest effect in patients with only microscopic disease where penetration of the drug into the tumor tissue is greatest. As tumor bulk increases, the concentration of drug that reaches the center of the tumor decreases.