Is there a role for IP chemotherapy in advanced mucinous ovarian cancers following complete cytoreductive surgery?

Specifically, if they are to be treated similar to GI cancers that receive FOLFOX/EPIC

1 Answer

Mednet Member

Gynecologic Oncology · University of Texas MD Anderson Cancer Center

Answered on

Whether there is a role for IP chemotherapy in advanced mucinous ovarian cancer following complete cytoreductive surgery, in my opinion, remains unknown. Because of the extreme rarity of mucinous ovarian cancer, this question may never be fully answered. For example, in the landmark study by Armstrong et al., N Engl J Med 2006, in which 429 patients with stage III epithelial ovarian/peritoneal cancer were randomized to either IV paclitaxel/cisplatin versus IV paclitaxel + IP cisplatin/paclitaxel, the IP cohort had a significantly improved overall survival but experienced greater toxicity. In this study, there were no patients with mucinous carcinoma identified, although there were 13 patients with "other" histology, which could have included mucinous subtype.

However, a subsequent phase III trial, GOG 252, completely called into question the superiority of IP chemotherapy (Walker et al. J Clin Oncol 2019). In this trial, a total of 1,560 patients were randomized to either IV weekly paclitaxel + IV carboplatin versus IV weekly paclitaxel + IP carboplatin versus IV paclitaxel + IP cisplatin/paclitaxel. In addition, all patients received bevacizumab. Compared with the IV carboplatin regimen, the duration of progression-free survival was not significantly improved with either IP regimen. Furthermore, in the trial, there were only 12 women with mucinous carcinoma. The major emphasis in studying mucinous ovarian cancer over the past few years has been on attempting to learn whether gastrointestinal-type chemotherapy may be superior to the traditional paclitaxel/carboplatin regimen.

MEOC/GOG 241 attempted to address this question but failed due to slow accrual and early closure of the study (Gore et al. Gynecol Oncol 2019). In a recent retrospective study, 52 patients with mucinous ovarian cancer received either a gastrointestinal-type chemotherapy regimen or a standard gynecologic regimen (Kurnit et al. Obstet Gynecol 2019). The GI-type regimen was found to be associated with improved survival. In summary, we do not know whether IP chemotherapy provides any advantage over IV chemotherapy for mucinous ovarian cancer. Mucinous ovarian cancer remains a challenging subtype to study prospectively due to its extreme rarity.