Intraperitoneal carboplatin could be used as first-line treatment in ovarian cancer

Intraperitoneal chemotherapy effectively reduces mortality in patients with advanced epithelial ovarian cancer history. However, this is not used widely in practice. Researchers performed the Intraperitoneal Therapy for Ovarian Cancer with Carboplatin (iPocc) trial in women receiving intravenous paclitaxel (80 mg/m2 on days 1, 8, and 15 of a 21-day cycle) after an ovarian cancer diagnosis.

The control group patients were given IV carboplatin (dose-dense intravenous paclitaxel plus intravenous carboplatin [dd-TCiv]), and the experimental group received dose-dense intravenous paclitaxel plus intraperitoneal carboplatin (dd-TCip).

The progression-free survival (PFS) was the principal or primary outcome.

Secondary endpoints included overall survival, tumour response, treatment completion rate, and incidence of adverse events (AEs).

The study results could be summarised as follows:

• Six hundred fifty-five patients were randomized to treatment; median PFS was 20.7 and 23.5 months for dd-TCiv and dd-TCip, respectively, with a hazard ratio of 0.83.
• The PFS benefit with dd-TCip was consistent in patients with different baseline characteristics, stages, residual tumour size, age, and performance status.
• The treatment completion rates in the dd-TCiv and dd-TCip groups were 68.3 and 59.9%, respectively.
• There was a 10.1 % incidence of intraperitoneal catheter-related AEs in the dd-TCip group.
• No AEs in the dd-TCiv group were reported.

Based on the study’s finding, intraperitoneal carboplatin modestly prolonged PFS when given with dose-dense weekly paclitaxel regardless of residual tumour size, with no impact on noncatheter-related toxicities.

Japan Agency for Medical Research and Development funded the study.

The study’s limitations were the small population of non-Japanese patients, and limited generalizability, lack of molecular stratification.

Further reading:

https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200225