Recommended chemotherapy administration method found underutilized

The National Cancer Institute recommended administering chemotherapy directly into the abdomen as a treatment for ovarian cancer. Nine years after the recommendation was made, adoption of the drug delivery technique remains low, a study just published in the Journal of Clinical Oncology found.

The benefits of intraperitoneal chemotherapy (or administration into the abdomen's peritoneal cavity) is about a 12-month improvement in median overall survival time, the NCI said in its recommendation. Using more recent real-world data, the study found that the IP chemotherapy increases 3-year overall survival from 71% to 81%, and another study in the same journal concluded that among women tracked for 10 years, those who received drugs via the intraperitoneal administration route had 23% lower risk of dying.

Still, less than half of eligible patients at 6 elite National Comprehensive Cancer Network institutions received IP chemotherapy, the study says. The rate varied from 4% to 67%, depending on the institution (though the study did not specify which centers were the high and low adopters). And the adoption rate is likely even lower at less prestigious cancer centers.

One reason for the low rate of adoption is the difficulty and length of time involved in IP chemotherapy, compared to the standard intravenous route, The New York Times reports.

IP chemotherapy involves the infusion of the generic drugs cisplatin and paclitaxel through a catheter that's connected to a disc-shaped port implanted under the skin and against a bone in the abdominal wall. It's given to women with ovarian cancer whose tumors have spread inside the abdomen, making it a targeted form of drug delivery.

The NCI said the impact of the new administration technique upon survival is similar to when the generic drugs themselves were added to the treatment regimen for ovarian cancer.

Other reasons given for the technique's low uptake include its toxicity, and use of standard devices and generic drugs, which means doctors have less financial incentive to offer the procedure and companies don't provide training or encouragement, The Times reports.

"We suspected that even at the best centers there would be low integration of IP chemotherapy, but we were surprised to see how low it was across academic centers, and also to see how much variation there was between centers," study co-author Dr. Alexi Wright, and oncologist at the Dana-Farber/Brigham and Women's Cancer Center in Boston, told The Times. "It's the best data we have for improving survival among patients with this cancer."

Dr. Deborah Armstrong of Johns Hopkins Kimmel Cancer Center, who spearheaded the NCI's 2006 recommendation, called on patients and their advocates to demand the treatment.

- here's the study abstract | here's the entire article
- here's The New York Times take (sub. req.)

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