Dr. Wenham on Trials Evaluating IP, IV, and Dose-Dense Chemotherapy in Ovarian Cancer

Robert M. Wenham, MD, gynecologic oncologist and chair of the Gynecologic Oncology Program at Moffitt Cancer Center, discusses data with intraperitoneal (IP) chemotherapy, dose-dense chemotherapy, and intravenous (IV) chemotherapy in patients with advanced ovarian cancer.

The decision between giving IP, IV, or dose-dense chemotherapy has been confounded by clinical trial data, explains Wenham. Three randomized trials—SWOG-8501/GOG-104, SWOG-9227/GOG-114, and GOG-172—showed about a 20% to 25% improvement in overall survival with IP chemotherapy. However, the approach wasn’t widely adopted because many women aren’t treated at centers that are equipped to deliver IP chemotherapy, says Wenham. Additionally, toxicity concerns were associated with the approach. However, while IP chemotherapy can be more cumbersome to give, it shouldn’t be more toxic than standard approaches, says Wenham.

Although the GOG-252 trial was designed to evaluate IP chemotherapy, it examined dose-dense chemotherapy versus IP chemotherapy in addition to bevacizumab (Avastin). The trial design was similar to that of GOG-262, in which bevacizumab was given in combination with dose-dense and weekly chemotherapy. In the GOG-262 trial, dose-dense chemotherapy was superior to every-3-week administration. However, in the 15% of patients who received every-3-week administration and bevacizumab, patients experienced similar outcomes as those who received dose-dense chemotherapy.