A comparison of the toxicity and tolerability of two intraperitoneal chemotherapy regimens for advanced-stage epithelial ovarian cancer

• Randomized controlled trials have demonstrated significant survival benefits with intraperitoneal cisplatin.
• Intraperitoneal carboplatin has less gastroinstinal, neurologic and hematologic toxicities than intraperitoneal cisplatin
• High quality studies are evaluating the role of intraperitoneal carboplatin in optimally cytoreduced advanced ovarian cancer.

ObjectivesRandomized controlled trials (RCTs) in optimally cytoreduced epithelial ovarian cancer (EOC) patients have demonstrated an impressive survival benefit of intraperitoneal (IP) platinum over intravenous (IV), but its use has been limited by significant toxicity from cisplatin. The aim of this study was to compare the toxicity and tolerability of IP cisplatin to IP carboplatin in women with optimally cytoreduced EOC.MethodsRetrospective analysis of 141 women with EOC who underwent optimal surgical cytoreduction followed by IV paclitaxel and IP cisplatin or IP carboplatin was performed. Toxicities of the two treatment regimens were compared. As a secondary outcome, overall survival (OS) and progression-free survival (PFS) probabilities were obtained using the Kaplan–Meier estimate; the log-rank test was used to compare survival curves.ResultsOf the 141 patients, 77 (54.6%) received IP cisplatin and 64 (45.4%) received IP carboplatin. Eighty-six percent received at least 4 cycles of IP chemotherapy. IP cisplatin was associated with significantly more grade 3 nausea and vomiting (10.4% vs 1.6%, p = 0.033), grade 3 neuropathy (7.8% vs 0%, p = 0.013) and grade 2–3 neutropenia (22.1% vs 9.4%, p = 0.042). No difference in PFS (p = 0.602) or OS (p = 0.107) was found between the groups.ConclusionIP chemotherapy had a high completion rate in both groups of patients. IP carboplatin required a less resource intense protocol and was tolerated better than IP cisplatin with less gastrointestinal, neurologic and hematologic toxicities.