Suepr~Info re IV vs IP chemo treatments & related info 4 Ovarian Cancer w/multiple references

LorettaMarshall · March 2018

Good afternoon ~ May I call you Sue?

As for your question about IP vs IV, you will probably get a more current answer if you will start your OWN topic forum on this same link, for this reason. You have put your query on a link that first began in 2011. That was 7 years ago. Now the only one that is posting currently on different topics is “Tethys41.” She is a survivor of Stage III OC for a long time and her tests show NED presently. That’s always the best news. So I’ve taken it upon myself to start a new topic forum for you specifically. If you will come back “here” for additional comments and questions, you will hear from the women who currently post here. So here is your posting this morning. My comments follow your post.

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https://csn.cancer.org/comment/1620446#comment-1620446 –

“Suepr - IP Chemo - Mar 10, 2018 - 7:39 am -

I have just been diagnosed with stage 4 ovarian cancer and have started IP chemo. I am new to this chat stuff and this website. What does NED stand for? I had my first treatment 1 week ago and was in the hospital overnight due to the slow IV infusion of Taxol. I am getting Cisplatin but that was pretty quick. I will IP Taxol on day 8. I am curious if it is easier than the IP cisplatin or not. It is good to hear all the comments.”

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So Sue – here are my personal comments in answer to your posting this morning.

NED stands for “No evidence of Disease”. (The first reference #1 below will give you a list of cancer terms and acronyms. You will find NED listed in the “N” section naturally. I’m forever seeing abbreviations that I don’t understand. The first time I saw the letters “NED”, I didn’t know what it meant either.

As for me, I’ve been a survivor for 5 years now. I started out diagnosed as a Stage IV cancer, Peritoneal Carcinomatosis. It was first discovered in the peritoneal fluid in my abdomen. A second opinion, exploratory surgery and a PET/CT scan at the University of Pittsburgh Medical Center, (UPMC) revealed it to be also in my ovaries. So we never bothered to figure out which came first. At that point, it didn’t matter, it was Stage IV!

I had pre-op (neoadjuvant) chemo, then Cytoreductive Surgery at the University of Pittsburgh Medical Center July 1, 2013. I then had targeted radiation (Cyberknife) that successfully eliminated 3 cancerous nodes on the Caudate Lobe of my Liver. Then in subsequent years, 2015, 2016, and 2017 I have had 6-regimen treatments of the same drug. As for me, I am currently undergoing IV treatments of Carboplatin/Paclitaxel (Taxol) once more. Each time seems to give me about 10 months at most of “symptom free” or “Progression free survival” commonly referenced as “PFS” but never “No Evidence of Disease (NED). So far the quality of life I enjoy has been “worth” the side effects of the 6-regimen chemo treatments given 3 weeks apart.

But like I said, many women are on this site and will be glad to share their experiences with you. I have included some references below my name that are directly related to your question of IP or IV. They are technical in nature, and much is there that I don’t attempt to decipher, but I can usually read the “abstract” and the “conclusions reached” and that tells me all I need to know about that particular study or clinical trial.

There is often an IP infusion that comes at the end of a Cytoreductive surgery for those women who qualify for that particular surgery known as HIPEC. I note that when women are first diagnosed with Ovarian Cancer that sometimes pre-op (neoadjuvant) chemo is ordered then a surgery follows. At other times, surgery comes first, and then post-op (adjuvant) chemo. However, as I scan the articles written below, it seems that women who have the intravenous infusions experience less toxicity.

I have read articles below that say that the IP infusions are more difficult to “complete” the required number of cycles than those who have the standard “IV” infusions. At this point, this is probably information “overload” unless you have a background in medical speak, which I do not. But I’ve been able to learn all I think I need to understand concerning my own cancer.

The word neoadjuvant means “before”, and the word “adjuvant” means “after” when referencing sequence of events. So in my case, I had “neoadjuvant” chemo, then the surgery. Moreover what is removed during surgery will depend on each individual and their own particular diagnosis.

So here’s hoping that you’ll be a quick learner, and find out all you can about your own Ovarian Cancer Stage and what treatments are best recommended. For most of us, or at least speaking for myself, I knew nothing about Ovarian cancer except how to spell it. But when it has your name attached, then it gets “personal.”

Love Loretta

Peritoneal Carcinomatosis/Ovarian Cancer Stage IV first diagnosed in 2012 and still blessed to be here.

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1. http://www.cancerindex.org/medterm/medtm15.htm

15: Abbreviations and Acronyms for Oncology

Contents

Introduction
List of Abbreviations
List of Acronyms of Cancer Organisations
The Female Reproductive Organs
Combined List of Abbreviations and Acronyms
Introduction

This section aims to provide a reference list of abbreviations and acronyms that are frequently used within oncology.

As well as many widely used medical abbreviations this text includes abbreviations that have meaning only within oncology, sub-specialties or even particular organisations. No definitive list of standard abbreviations exists therefore it is important to understand the context in which they have been used in.

For example "PNET" usually refers to a type of brain tumour, however, within orthopedic oncology the same abbreviation has been applied to a form of sarcoma. You may also find it useful to have access to a medical dictionary or text-book that contains a list of common abbreviations used within the wider field of medicine.

This list of has been compiled over a number of years and abbreviations have been collected from a wide range of sources including journal articles and conference presentations.

Acknowledgements Thanks to the following who have contributed additional abbreviations to this list; Jane Evans, Kevin Fishwick, Anna Mitchell, Moira Stewart and the staff of the former UKCCSG Data Centre.

List of Abbreviations

Shortcuts: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z…”

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2. https://www.cancer.gov/publications/dictionaries/cancer-terms/search?contains=false&q=ovarian

This is a self-pronouncing dictionary of cancer terms. Key in the word you want to know more about. There is an “AUDIO” symbol as well that will let you hear how the word is pronounced.

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3. http://news.cancerconnect.com/types-of-cancer/ovarian-cancer/ovarian-cancer-overview/

“…Because epithelial ovarian cancers begin deep in the pelvis, they often do not cause any symptoms until they are at an advanced stage. Furthermore, many of the symptoms of ovarian cancer are hard to differentiate from symptoms experienced by women who do not have ovarian cancer, such as back pain, fatigue, abdominal bloating, constipation, vague abdominal pain, and urinary symptoms. Because of the lack of specificity of early ovarian cancer symptoms, [2] the majority of women (roughly 70%) already have advanced cancer at the time of diagnosis.[3] Ovarian cancer is often originally suspected in women when their physician finds an abnormal pelvic growth during an internal pelvic examination. Ovarian cancer may spread to the lining of the abdominal cavity and lead to the buildup of fluid inside the abdomen, called ascites. Ovarian cancer may cause symptoms such as swelling of the abdomen, pain, irregular bowel movements or difficulty breathing when fluid places pressure on the lungs…”

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4. https://medlineplus.gov/ovariancancer.html

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5. https://www.cancer.gov/types/ovarian/patient/ovarian-prevention-pdq#section/_4

(“About PDQ - Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about ovarian, fallopian tube, and primary peritoneal cancer prevention. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care…Last update February 23, 2018)”

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6. https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941

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7. https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/diagnosis-treatment/drc-20375946

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8. https://www.bing.com/videos/search?q=ovarian+cancer+videos&view=detail&mid=75C32FB6AECC3EA1BA9475C32FB6AECC3EA1BA94&FORM=VIRE

A 34:41 minute video from an Ovarian Cancer patients talking about their diagnoses.

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9. https://www.cancer.org/cancer/ovarian-cancer/treating/chemotherapy.html

“Chemotherapy for Ovarian Cancer

Chemotherapy (chemo) is the use of drugs to treat cancer. Most often, chemo is a systemic treatment − the drugs are given in a way that lets them enter the bloodstream and reach all areas of the body. Systemic chemo can be useful for cancers that have metastasized (spread). Most of the time, systemic chemo uses drugs that are injected into a vein (IV) or given by mouth. For some cases of ovarian cancer, chemotherapy may also be injected through a catheter (thin tube) directly into the abdominal cavity. This is called intraperitoneal (IP) chemotherapy. Drugs given this way are also absorbed into the bloodstream, so IP chemotherapy is also a type of systemic chemo. This is discussed in more detail later in this section.

Chemotherapy for epithelial ovarian cancer

Chemo for ovarian cancer is most often a combination of 2 or more drugs, given IV every 3- to 4-weeks. Giving combinations of drugs rather than just one drug alone seems to be more effective in the initial treatment of ovarian cancer.

The standard approach is the combination of a platinum compound, such as cisplatin or carboplatin, and a taxane, such as paclitaxel (Taxol^®) or docetaxel (Taxotere^®). For IV chemotherapy, most doctors favor carboplatin over cisplatin because it has fewer side effects and is just as effective.

The typical course of chemo for epithelial ovarian cancer involves 3 to 6 cycles. A cycle is a schedule of regular doses of a drug, followed by a rest period. Different drugs have varying cycles; your doctor will let you know what schedule planned for your chemo.

Epithelial ovarian cancer often shrinks or even seems to go away with chemo, but the cancer cells may eventually begin to grow again. If the first chemo seemed to work well and the cancer stayed away for a long time (at least 6 to 12 months), it can be treated with additional cycles of the same chemotherapy used the first time. In some cases, different drugs may be used…

Intraperitoneal chemotherapy

In intraperitoneal (IP) chemotherapy for ovarian cancer, in addition to giving the chemo drug paclitaxel IV, the drugs cisplatin and paclitaxel are injected into the abdominal cavity through a catheter (thin tube).

The tube can be placed during the staging/debulking surgery, but sometimes it is placed later. If it is done later, it can be placed by a surgeon using laparoscopy, or by an interventional radiologist under x-ray guidance. The catheter is usually connected to a port, a half dollar-sized disk topped with a pliable diaphragm. The port is placed under the skin against a bony structure of the abdominal wall, such as a rib or pelvic bone. A needle can be placed through the skin and into the port to give chemo and other drugs. Over time, problems may rarely occur with the catheter. − It may become plugged or infected or even damage the bowel.

Giving chemo this way gives the most concentrated dose of the drugs to the cancer cells in the abdominal cavity. This chemo also gets absorbed into the bloodstream and so can reach cancer cells outside the abdominal cavity. IP chemotherapy works well, but the side effects are often more severe than with regular chemo. In a study of women with advanced ovarian cancer, women getting the IP chemotherapy had more abdominal pain, nausea, vomiting, and other side effects than the women getting chemo through the vein. These side effects actually made some women stop their treatment early. Still, the women getting IP chemotherapy lived longer than the women getting regular chemo.

IP chemotherapy currently is only given to some of the women with ovarian cancer that has spread to the inside of the abdomen. It was only studied in women whose cancer had not spread outside the abdomen (stage III) and who had no tumors larger than 1 cm after surgery (optimally debulked).

Also, because it can be so toxic, women must have normal kidney function and be in good overall shape for their doctor to be willing to try IP chemo.

They also cannot have a lot of adhesions or scar tissue inside their abdomen because this can prevent the chemo from spreading well…”

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10. http://www.croh-online.com/article/S1040-8428(06)00229-0/pdf

“SHOULD INTRAPERITONEAL CHEMOTHERAPY BE CONSIDERED AS STANDARD FIRST-LINE TREATMENT IN ADVANCED STAGE OVARIAN CANCER?...

Abstract Current standard therapy for patients with advanced stage epithelial ovarian cancer is cytoreductive surgery followed by combination chemotherapy with paclitaxel and carboplatin. Intraperitoneal (IP) chemotherapy has demonstrated improved outcome compared to standard intravenous treatment in three large randomized phase III trials and confirmed by Cochrane meta-analysis.

Although compelling evidence suggests that IP therapy provides survival benefit in a selected group of ovarian cancer patients, it remains unclear which group of patients will really benefit from IP therapy, which is the optimal drug, dose and combination, and what is the real benefit of IP treatment alone.

Other concerns about IP therapy are difficulties in completing the assigned treatment and management of its pattern of toxic side-effects.

Today, IP chemotherapy has yet to gain a role as standard first-line treatment in advanced stage ovarian cancer. In the near future, efforts should aim at developing an effective IP regimen and research undertaken for a better understanding of the peritoneal environment. © 2006 Elsevier Ireland Ltd. All rights reserved…”

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11. https://synapse.koreamed.org/Synapse/Data/PDFData/0063JKMS/jkms-32-2021.pdf

“LONG-TERM SURVIVAL ANALYSIS OF INTRAPERITONEAL VERSUS INTRAVENOUS CHEMOTHERAPY FOR PRIMARY OVARIAN CANCER AND COMPARISON BETWEEN CARBOPLATIN- AND CISPLATIN-BASED INTRAPERITONEAL CHEMOTHERAPY

In epithelial ovarian cancer (EOC), intraperitoneal (IP) administration of chemotherapy is an effective first-line treatment and may improve outcomes, compared with intravenous (IV) chemotherapy.

We used Kaplan-Meier survival analysis to compare long-term survival between propensity score-matched patients with advanced EOC receiving IP (n = 34) vs. IV (n = 68) chemotherapy.

Additionally, clinical features associated with carboplatin-based (n = 21) and cisplatin-based (n = 16) IP chemotherapy were analyzed and compared with those associated with IV chemotherapy. The IP and IV chemotherapy groups had a median follow-up duration of 67 (range, 3–131) and 62 (range, 0–126) months, respectively, with no significant difference in progression-free survival (PFS) (P = 0.735) and overall survival (OS) (P = 0.776).

A significantly higher proportion of patients in the IV (91.2%) than in the IP (67.6%) chemotherapy group (P = 0.004) received ≥ 6 cycles.

However, the frequency of toxic events (anemia, granulocytopenia, nausea/vomiting, abdominal pain, hepatotoxicity, neuromuscular effects) was significantly higher in the IP than in the IV group.

Within the IP group, no significant differences were observed in PFS (P = 0.533) and OS (P = 0.210) between the cisplatin-based and carboplatin-based chemotherapy subgroups.

The 10-year OS was 28.6% and 49.2% in carboplatin-based and cisplatin based IP chemotherapy groups, respectively.

Toxic events (granulocytopenia, leukopenia, nausea/vomiting, abdominal pain, hepatotoxicity, neuromuscular effects) were significantly more common in the cisplatin-based subgroup.

In patients with EOC, cisplatin-based IP chemotherapy may be an acceptable alternative to IV chemotherapy regarding long-term survival, but toxicity must be addressed…”

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Suepr~Info re IV vs IP chemo treatments & related info 4 Ovarian Cancer w/multiple references

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