Combining a maximal debulking strategy and intraperitoneal chemotherapy could maximize the chance of achieving a cancer-free state, according to a recent perspective piece published in Nature Reviews Oncology (doi:10.1038/nrclinonc.2015.224). This argument for a new standard of treatment for women with late-stage ovarian cancer was written by Steven Narod, MD, of the Women’s College Research Institute in Toronto, Ontario, Canada.
“For decades, women have been treated with a combination of treatment options, resulting in poor prognosis for most women with advanced-stage ovarian cancer, but there are many survivors as well,” Narod explained.
Narod used an analysis of existing evidence to argue that to achieve a cure, rather than simply delay progression or recurrence of the disease, women should be first treated with aggressive surgery to remove all clinically detectable cancer cells, followed by targeted chemotherapy to the abdomen (intraperitoneal chemotherapy).
Improving the current 20% survival rate to a 50% cure rate would be significant. Conventional options offered to patients combine different methods, such as chemotherapy before surgery; postoperative chemotherapy delivered intravenously to the whole body, as opposed to localized into the abdomen; and surgery that leaves minimal residual disease in the abdomen, rather than removing all visible cancer cells.
Narod made a series of recommendations. First, offer chemotherapy after the surgery rather than before. Be aggressive with the surgery in an attempt to remove all visible signs of the tumor, and avoid leaving any residual disease. The goal is to have no cancer visible to the naked eye of the surgeon after the surgery.
Follow surgery with intraperitoneal chemotherapy delivered to the abdomen. Localized chemotherapy has the best results if no residual cancer is left after the initial surgery. The combined effect of surgery and chemotherapy works best.
“Women need support to endure surgery and the rigors of intraperitoneal chemotherapy, but should be encouraged to do so whenever possible, considering the potential survival benefits,” said Narod. “We should offer all women the possibility of a cure.”