Intraperitoneal chemotherapy should be first-line therapy in ovarian cancer
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A large number of pre-clinical data and the right abdominal anatomy, physiology and biology of ovarian cancer have suggested that understanding, abdominal local cytotoxic drug treatment for ovarian cancer is very reasonable. Intraperitoneal chemotherapy Phase I clinical trial confirmed the chemotherapy drugs and intraperitoneal chemotherapy safety of the technology itself, confirmed the intraperitoneal chemotherapy in the pharmacokinetic advantages.
In some multi-center Phase II clinical trials, surgical results confirmed that about 20% to 40% of second-tier category to cisplatin-based chemotherapy in patients with celiac complete remission, the part of the residual cancer patients <0.5 cm before acceptable to platinum-based chemotherapy effective systemic System .
Intraperitoneal chemotherapy in the study, there are three well-designed Phase III clinical trial results of the most meaningful.
1. Intravenous injection of cisplatin and intraperitoneal administration means of comparison:
Research into residual tumor less than 2 cm in the results showed that intraperitoneal administration can reduce tinnitus and neutropenia occurred in the rate of increase in the incidence of pain, prolong the survival period (intraperitoneal administration of intravenous infusion for 49 months to 41 months, P = 0.02 ).
2. Paclitaxel cisplatin and intravenous cisplatin intraperitoneal administration of intravenous paclitaxel comparison:
Research into the largest residual tumor 1 cm with intraperitoneal administration of cisplatin patients receive two courses of chemotherapy with carboplatin, the residual tumor foci by the chemical eliminate. Results showed that intraperitoneal administration of cisplatin group no progress was significantly longer survival time (28 months to 22 months), overall survival was significantly longer duration (63 months to 52 months).
3. Paclitaxel intravenous cisplatin and intraperitoneal administration of cisplatin paclitaxel (intraperitoneal administration vein ) comparison:
Pilot Group, a day of intravenous paclitaxel, cisplatin, 2 Erik intraperitoneal administration, intraperitoneal administration of Taxol eight days, each course of 21 days. The results confirmed that intraperitoneal chemotherapy can improve the survival rate of progress.
These Phase III test results confirmed that compared with systemic chemotherapy, intraperitoneal injection of cisplatin as first-line chemotherapy program enables residual tumor smaller in patients with advanced ovarian cancer recurrence and mortality reduction of 20% to 25%. Unfortunately, researchers have overlooked these important discovery, perhaps because cisplatin cause vomiting, and other side effects, so doctors do not want to implement, patients are unwilling to accept.
Intraperitoneal chemotherapy for ways to reduce the toxicity of two recommendations:
1. Reduce the amount of cisplatin, from 100 mg/m2 to 75 mg/m2;
2. Replace with cisplatin and carboplatin in ovarian cancer intraperitoneal chemotherapy using carboplatin replace cisplatin is very reasonable, and the above-stage Phase II clinical trials have confirmed the intraperitoneal chemotherapy carboplatin safety and effectiveness.
Currently the test is required for the small residual tumor in patients with ovarian cancer, carboplatin with carboplatin intraperitoneal administration of intravenous respectively as first-line chemotherapy for direct comparison. In the coming months, the United States Association of Gynecologic Oncology (GOG) will launch a similar study, if the study can be "intraperitoneal chemotherapy is superior to intravenous chemotherapy," the result of small residual tumor in patients with advanced ovarian cancer treatment model will change.
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