A study recently published in the Journal of Clinical Oncology found that fewer than 50% of eligible patients with debulked Stage 3 ovarian cancer treated at National Comprehensive Cancer Network (NCCN) centers have received the treatment most recommended by NCCN guidelines.
The recommended treatment, first published in 2006, consists of intraperitoneal (IP) administration of chemotherapy medication to patients in addition to intravenous (IV) chemotherapy. This allows the drugs to be directly infused into the abdomen, where it can come in direct contact with cancer cells at higher concentrations than when administered intravenously.
The new study, led by Alexi A. Wright, Dana-Farber Cancer Institute (Boston, MA), presented real-world evidence confirming the original clinical trial result that this method helps women with ovarian cancer to live longer: 3-year survival among women who had IP and IV treatment was 81%, compared with 71% in women who had IV chemotherapy only. The treatment was also found to be well-tolerated, with almost 90% of participants completing the treatment course.
The study found that, across the six cancer centers, use of IP chemotherapy in qualifying patients increased from 0–33% in 2003–2006 to 43% after the NCI issued an alert recommending the treatment in January 2006, and then to 50% in 2007–2008. and then plateaued, ranging from 4% to 67% use at these cancer centers. This variation in use among IP chemotherapy likely reflects the fact that physicians must optimize the treatment approach for the individual patient; patients receiving IP treatment were more likely to be young and with fewer comorbidities. In fact, the authors caution that this may present a selection bias that contributed to their findings of improved survival.
According to experts, there are a variety of reasons that may explain why the treatment is so underused. For one, the therapy is more difficult to administer than IV therapies or oral medications, because it must be infused through a port or catheter that is inserted through the patients’ abdomen. For another, practitioners may be concerned about toxicity. Another major factor is cost: infusion therapies are time-consuming, placing a high demand on healthcare providers’ resources, and the generic drugs comprising the treatment make little money for oncologists.
Such generic drugs also fall by the wayside as new treatments come on the market. And perhaps rightfully so: several new IV treatments for ovarian cancer have come onto the market for the treatment of ovarian cancer since 2006, many of which have shown promising results in clinical trials and have yet to be evaluated thoroughly in real-world populations. The authors point out that the use of such treatments as viable alternatives to the recommended IP treatment may explain why the survival benefit shown in the study was not even greater.
Wright and her colleagues conclude that women may receive substantially different treatment, depending on where they seek care, even within NCCN centers, and suggest that additional interventions may be required to ensure that treatment decisions are more uniform and patient-centered.—Kara Rosania
