In patients with stage III ovarian cancer, the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery significantly improves centrally assessed recurrence-free and overall survival, according to results of a study now published in the International Journal of Gynecological Cancer.
By enhancing the penetration of chemotherapy at the peritoneal surface, HIPEC has been found to improve outcomes in patients with advanced ovarian cancer. However, the efficacy of HIPEC in combination with interval cytoreductive surgery has not yet been established.
In a central radiologic assessment of the open-label phase 3 OVHIPEC-1 trial, a team of researchers led by first author Simone N. Koole, MD, of the Department of Medical Oncology at the Netherlands Cancer Institute, investigated the benefit of adding HIPEC to interval cytoreductive surgery in patients with stage III ovarian cancer. The trial enrolled 245 patients, who were randomized to undergo interval cytoreductive surgery with or without HIPEC. All patients received three cycles of neoadjuvant chemotherapy both before and after surgery, and those in the HIPEC group received an additional 100 mg/m2 of cisplatin. Computed tomography (CT) scans were performed during chemotherapy and follow-up and were reviewed by radiologists upon completion of treatment. The primary end point was recurrence-free survival, with secondary end points of overall survival and the incidence of peritoneal recurrence.
Scans were available for central review for 231 patients (94%) during neoadjuvant treatment and for 212 patients (87%) during the follow-up period. In patients receiving HIPEC plus surgery, the centrally assessed median recurrence-free survival was 13.2 months, compared with 9.9 months for those undergoing surgery alone, with a hazard ratio of 0.72 for recurrence or death. The improvement in survival was irrespective of baseline peritoneal cancer index or response to neoadjuvant chemotherapy. Patients receiving HIPEC plus surgery experienced a lower cumulative incidence of peritoneal recurrence, although the incidence of extraperitoneal recurrence remained unchanged.
"Centrally assessed recurrence-free survival analysis confirms the benefit of adding HIPEC to interval cytoreduce surgery in patients with stage III ovarian cancer, with fewer peritoneal recurrences," conclude Dr. Koole and colleagues. "These results rule out radiological bias caused by the open-label nature of the study."
For More Information
Koole SN, Bruijs L, Fabris C, et al (2020). Central radiology assessment of the randomized phase III open-label OVHIPEC-1 trial in ovarian cancer. Int J Gynecol Cancer. [Epub ahead of print] DOI:10.1136/ijgc-2020-001825
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