Intraperitoneal Hyperthermic Chemotherapy May Improve Survival in Ovarian Cancer

This is what I always promote, but it's so rare here!

Intraperitoneal Hyperthermic Chemotherapy May Improve Survival in Ovarian Cancer

According to an article recently published in Gynecologic Oncology, intraperitoneal administration of hyperthermic chemotherapy may improve survival among patients with Stage III ovarian cancer.

Ovarian cancer remains the most deadly of gynecologic cancers.  Cure rates for all stages combined are less than 40%. Stage III ovarian cancer refers to cancer that has spread from the ovaries and pelvic organs into the upper abdomen or lymph nodes but not to sites outside the abdomen or inside the liver. Researchers continue to evaluate novel ways to treat ovarian cancer in the hopes that outcomes can be improved.

Intraperitoneal administration of chemotherapy, which is administration directly into the abdomen, has demonstrated a benefit over conventional intravenous administration for ovarian cancer. In intravenous administration chemotherapy is delivered into a vein and then circulates throughout the body; a limitation of this delivery method is that it tends to create significant side effects. Intraperitoneal administration, on the other hand, can reduce some of the side effects associated with intravenous administration. As well, for some patients direct administration to the area of the cancer appears to more effectively kill cancer cells in that specific area than intravenous administration.

Hyperthermic chemotherapy refers to chemotherapy that is heated before it is infused. It is thought that hyperthermic chemotherapy may provide greater anticancer activity than standard chemotherapy. Intraperitoneal hyperthermic chemotherapy (IPHC), an investigative approach, refers to heated chemotherapy that is administered directly into the abdomen.

Researchers from South Korea recently reviewed clinical data involving IPHC among women with advanced ovarian cancer. This data included 96 patients who underwent initial surgery and chemotherapy. All patients then underwent a second surgery and IPHC. Twenty-two patients were treated with IPHC that included the chemotherapy agent paclitaxel; 45 patients were treated with IPHC that included the chemotherapy agent carboplatin; and 29 patients (control group) received standard therapy (no IPHC).

Among patients with Stage III ovarian cancer, survival at five years was nearly 85% for those treated with IPHC

[EchoUK]

When I was in hospital the lady in the next bed was diagnosed with a very rare cancer - PMP ( Pseudomyxoma peritonei) - and will be having surgery called the Sugarbaker technique which is only practised in a few specialist hospitals.  The operation will take 10 hours and part of it includes 90 mins warm chemo bath put in after surgery.

[dian07]

I am confused...why would this thermal treatment be offered to women with advanced ovarian cancer and not to women with stage I or II......seems to me it would benefit all who are dealing with this monster.....I can't imagine the side effects would be worse than carbo/taxol.....I was diagnosed IC as there were cells in the abdominal lavage.....in my opinion I was a perfect candidate for the procedure.  Just my opinion!
Peace.
dian

[alanpvegas]

I think that might have only be due to the study.  With Stage 1, the cancer is pretty much confined, so there is no seeding and it would cause more harm than good to do this beyond traditional surgery and possibly chemotherapy.  Anything Stage 2 and above would be assumed applicable to do this...but it all depends, it's not widely used unfortunatley...heck, many oncologists still don't do the recommended IP chemotherapy in general.

[Curls]

Hi, I think you were here when I was having surgery a year ago Jan?  Glad you are still going strong!!  At that time I'd seen an article and then seen a study post on the Hopkins site that was one of the very, very first of the these treatments.  My guess, you weren't offered it because it was still in early study stages and being offered only within the research efforts.  
Take care!

[dian07]

It is my opinion that the decision to have, or not to have, the IP thermal treatment at the time of surgery should be ddiscussed prior to surgery....that is a decision needing the attention of both the gyn/onc and the patient.....we are already in the hospital and pretty miserable....we could just stay the 9 days....where better to be for pain management, nutrition, rest etc. than in the hosp where your gyn/onc can keep an eye on you.....there is no easy way to do this....I think we should be given the option.  Maybe only one dose of the IP would make a difference in our sucess in killing the beast!  I know, I for one would have said if you find a malignancy take this opportunity to douse it with chemo perhaps killing all the seeds that just might be hiding somewhere.....I know it would have made me sick but I would have welcomed an opportunity to improve my chances of survival......and I think if I was at a later stage I would appreciate the opportunity even more.....after all....we are the ones whose bodies are being invaded and poisoned.  Just my opinion.
Peace.
dian

[YvonneS]

All of this sounds wonderful, but this is a horrible treatment.  1st dia in May 2005. 7 treatments taxol/carbo. Remission for 10 months.  (2nd occurance. Had major debulking in Nov) They wanted to do 6 treatment of IHC.  One treatment & everyone in my family, including me thought I was dying. Ended up in hospital for 5 days. Lost 20 lb  in 5 days.  Then GYN/ONO told me even in trials less than 40% of women could tolerate the treatments.  Then I went to Gemzer (or whatever) and carbo for 7 treatments.  CA125 is rising again.   Ono gave me 2 months off, but wanted CA125 in a month, which Ihad yesterday. Get results next week.  As so many other, I am just frustrated and see no end to what is going on.  I am 67.

[alanpvegas]

Yes very tough!  Before this report came out, the most it has been done was during surgery and that's it (as far as heated chemo IP).  IP chemo in general is very tough as it's coating all the organs in the cavity.

[nyc lady]

I think that most studies are done Stage 3 and higher as most women, unfortuantely, are not diagnosised until late stages.  This therapy, if showing any success, would be even more successful with lower staged cancers that already have a better survival rate.  When looking at the number of women dx'd with OvCa, which is considerably small (although near and dear to all of us and to me the one cancer I will spend the rest of my life volunteering to educate, support and help raise money for research)and most of those women something like 85 percent of those with OvCa are dx'd with stage 3A or higher, there are not many lower staged OvCa's in trial....also, another interesting statistic (was presented at a seminar by an GYN/ONC ) only like 5 percent of those dx'd go into trials.  If you break down the numbers in the United States it will look something like this:

approximate number of women dx'd with OvCa in a year - 23,000
stage 3A or later approximately 19,550
approximate number of women in a clinical trial is less then 1,000

I was trying to think the other day....how much experience do GYN/ONCs really have with OvCa?....there are really few cases when you think of the  amount of women in the United States.....how many GYN/ONCs are there in the US?  In my doctors office there are 3 of GYN/ONCs, within my NOCC group there are probably 7 to 10 different GYN/ONCs represented and we are not that big of a group....and of all the OvCa's that are dx'd there are many women that do not even survive the first line of treatment.

Pam

[lucymullis]

I just returned from the Ovarian Cancer National Alliance conference.  Dr. Bristow from Johns Hopkins talked about this in his presentation.  Dr. Bristow is well known in the OVCA community and has written several books, if you are interested. He does it there.  They do it the "shake and bake" way by putting it in during surgery, closing you up and then moving your abdomen around. He showed interesting slides and presented convincing data that was impressive.  I would certainly do this, if appropriate.  

[orangefuzzball]

I've got pseudomyxoma (PMP) which is a result of appendix cancer, mentioned by EchoUK, IPHC and radical cytoreduction are the gold standard treatment for this condition. The surgery and IPHC are seen as too extreme by a lot of surgeons and the chance of having PMP cured (50-80% 10 year cure after full procedure if all visible tumour is removed) is denied to too many PMP patients. I'm a great believer in this treatment being the way forward for ovarian, colon and peritoneal cancers, however the resistance of surgeons, the terrifying sound of the procedure and time and money are all obstacles. There is an awful lot of research out there about IPHC in relation to these cancers, unfortunately the studies are often on small numbers and virtually the only way to get the treatment is to be on a trial (unless you have PMP and then in the US it is deemed experimental by insurance companies and they have to fight tooth and nail to get it), DeMarco who posts occassionally on here was on a OVCA trial a couple of years ago and has had no reoccurance.

I had a 13.5 hour surgery on 23rd of April where the top half of my abdomen was stripped - that is spleen, gall bladder, entire omentum (rather than a normal omentectomy) and mesentry all removed: stomach, liver and diaphragm surfaces completely stripped, all abdominal linings/membranes removed, small bowel stripped and a resection. Followed by heated chemo directly into the abdomen for 90 minutes. I was in ICU for 7 days and a total of 12 days in hospital. I'll be having a similar procedure on the lower abdomen in about 3 months time.

It sounds pretty awful operation-wise, I haven't found it so! I had 5 hour surgery in August last year when the PMP was found (PMP is usually discovered in women when operating for stage 3-4 OVCA, very often mis-diagnosed or ignored by surgeons & oncologists as they don't know what it is, how to treat it or deem Sugarbaker procedure and IPHC barbaric) I haven't really felt any worse after this last operation with the IPHC. The type of chemo used may make a difference, it is not at all comparable to the normal IP chemo (that is by all accounts pretty tough) I had very slight hair thinning about 9 days post-op, my stomach is a little sore, I get breathless due to extensive work on my diaphragm, otherwise I look and feel completely 'normal', I don't have any health issues from the missing body parts and I'm unlikely to have any after my next op.

Although most OVCA patients won't need the massive surgery I had, all visible tumour has to be stripped. The chemo penetrates to about 3mm, if remaining tumour is visible it will not be destroyed by the chemo and the cancer will return. The IPHC is only done once - I think Prof Sugarbaker still uses IP chemo for 23 hours daily for 5 days post-op as well as intraoperatively, there's research to say that this isn't needed and causes more problems than it benefits. One of the things with the PMP is that it is so important to get to a surgeon that has done the full cytoreduction and IPHC many times - there are 2 teams in the UK that can do it and about 5-6 in the US. Others use patients as guinea pigs, often with bad results. Currently in the UK the procedure is only licenced to be done on PMP and only at Christie Hospital in Manchester and in Basingstoke, both hospitals do a couple of ops per week, the Christie's team is made up of regional specialist surgeons (I had 6 consultants surgeons/oncologist/anaethetist present for the full 13.5 hours!) I'm pretty sure that Dr Levine at St Agnes', Wakeforest and Prof Sugarbaker in Washington DC both operate on OVCA and colon cancer.

Lisa.

[SimplyStar]

Guess I am stuck still on the ability of ginger to kill cancer cells, would like to see  a trial of a heated ginger wash after bebulking or one when a reurrance occurs use the IPHC with concertated ginger.  I think there would likely to be less side affects. I am beginning to think that the harsh chemo drugs are doing more harm then good and they need to start looking at the known cell killers for infusions. The body needs to stay strong to fight this and with drugs taking the counts down the body is losing that ability it naturerally has to fight  a foriegn invader.

[jdbobo]

It's important to understand there is a huge difference between IP chemo (body temperature chemo applied into the abdomen via a port) vs. IP hypothermic chemo (IPHC) which is heated chemo applied (only once) as part of a surgical procedure.

I believe this particular study looked at the results of giving IPHC during a second look surgery for folks after their first line chemo.  Of course, there have been/will be other studies looking at IPHC to coincide with initial surgery, as well as using IPHC after surgical debulking for a recurrence.

It does generally appear that this is currently considered highly experimental, and it's expensive (it adds a couple hours to the surgery and probably a couple of days in intensive care), so finding a study/Dr./hospital to give it to you and an insurance company willing to pay for it might be a very serious challenge.

If anyone knows more about any studies/hospitals offering IPHC for OVCA in the States during a second look surgery, I'd love to hear more.

[lucymullis]

I asked my gyn/onc about it today.  He said it was like several other treatments...it seems to recycle to the front periodically.  He was not in favor of it at all and did not feel data supported it.  He also said it was hell on the patients.  My doc always says that if something is really effective, we'd be hearing about it being done more.  Just his view.

[deedee5827]

Okay, I am going into surgery on Monday for a second time.  I was diagnosed orig. Aug. 2005 and took 6 rounds of taxeter and carboplatin.  Fast forward, my CA125 went to 35 and we did a scan to find a mass in the pelvic area.  thought we would treat it with chemo but to my surprise my doctor is doing surgery with intrperitneal chemo after.  (Please forgive spelling) anyway has anyone gone through this type of chemo and what advice can you give me?  thanks, I'm 48 yrs. old.

[kdoc720]

any body knows if hyperthermic IP chemo is done in India anywhere?It would be of great help.thank

[yrrek]

Hi, it's me yrrek and I was diagnosed 1c and was offered IP was supposed to have 6 cycles of it only was able tolerate one.  It seems that my chemo was heated before putting into the peritoneal cavity and while it was running in it had something around it to keep it warm.  Also I wanted to do IP chemo again after the 3rd cycle to give myself every chance but my Onc. talked me out of it.  So I don't know.  My surgeon who did the debulking was surprised that my Onc was going to try this new agressive approach on my.  I am glad I did, and wished I could of tolerted more cycles that way.  I am 6 months post chemo with a steady CA125 of 8.  Kerry

[StillFighting]

I've had the IP chemo before, while not heated I was thankful for the interperatanial treatment. It saved major wear and tear on my veins. I was a guinie pig for this type of treatment delivery.

While I didn't have much problem with it I did have that bloated feeling in my stomach, but it was no worse than what you get when you have the fluid sacks growing. Everyone is different though and not all women can tolerate the ip port. good luck on your surgery. I hope everything turns out alright for ya.