Comparison of Primary Intraperitoneal Chemotherapy to Consolidation Intraperitoneal Chemotherapy in Optimally Resected Advanced Ovarian Cancer

Three phase 3 trials have shown a survival advantage for patients with optimally debulked (1 cm residual) stage III ovarian cancer who received intravenous (IV)/intraperitoneal (IP) chemotherapy compared with those who received IV therapy alone. In the most recent of these trials, a dramatic 16-month overall survival (OS) benefit was demonstrated for the IP arm. Few studies have compared survival outcomes following optimal debulking surgery for use of primary IV/IP to that of IV followed by consolidation IP chemotherapy. The aim of this study was to compare survival outcomes for patients with advanced epithelial ovarian cancer (EOC) treated with primary IV/IP chemotherapy to those who received IV followed by consolidation IP chemotherapy. From 2001 to 2005, a retrospective review identified 224 patients with stage III-IV EOC who underwent optimal primary cytoreduction (residual disease 1 cm) followed by cisplatin-based consolidation IP chemotherapy (n = 68; 28%) or primary IV/IP chemotherapy (n = 162; 72%) from 2005 to 2011. At presentation, the primary IP group had significantly more patients with serous tumors; the consolidation IP group had a significantly higher median preoperative platelet count, CA-125 level, and amount of ascites. There were no differences between groups in residual disease after cytoreduction. Median follow-up for the entire cohort was 50 months (58 months for the consolidation IP group and 49 months for the primary IP group). In univariate analysis, the primary IP group had longer median progression-free survival (PFS) than did the consolidation IP group, but the difference was not significant (23.7 vs 19.7 months); the hazard ratio (HR) was 0.78, with a 95% confidence interval (CI) of 0.57 to 1.06, P = 0.11. In contrast, median OS was significantly longer for the primary IP group (78.8 vs 57.5 months [HR, 0.56; 95% CI, 0.38-0.83]; P = 0.004). On multivariate analysis, the difference in PFS remained insignificant (HR, 0.78; 95% CI, 0.56-1.11; P = 0.17), whereas the difference in OS persisted (HR, 0.59; 95% CI, 0.39-0.89; P = 0.01). These data show that primary IV/IP chemotherapy in patients with optimally cytoreduced advanced EOC is associated with improved OS compared with IV followed by consolidation IP chemotherapy.