Living With Ovarian Cancer as a Chronic Disease, and Celebrating Milestones

Living With Ovarian Cancer as a Chronic Disease, and Celebrating MilestonesWhenever Joan Janssen meets fellow ovarian cancer patients, she shares words of wisdom that she’s gained from seven years of living with the disease. “This is a recurring disease; don’t be stunned if it comes back,” she tells them. “You fought it the first time. You can do it even better the next time.”

Janssen has experienced her share of “next times.” After she was diagnosed in September 2010 with ovarian cancer, her disease recurred twice while she was on chemotherapy. But after she transitioned to clinical trials for targeted therapies at Dana-Farber’s Susan F. Smith Center for Women’s Cancers, Janssen’s condition stabilized. She is managing her ovarian cancer as a chronic disease and celebrating many more milestones with her family in Sun Prairie, Wisconsin.

As recently as up to 10 years ago, ovarian cancer patients had fewer options for treatment. But targeted therapies – which look to exploit genetic changes in cancer cells and make them molecular targets for “smart” drugs – have resulted in better outcomes for some ovarian cancer patients.

“The development of targeted therapies such as PARP inhibitors and antibody drug conjugates has been critical in giving ovarian cancer patients more options,” says Ursula Matulonis, MD, director of Gynecologic Oncology at the Susan F. Smith Center. “By interfering with the repair of damaged DNA in cancer cells, PARP inhibitors have proven quite effective in treating high-grade serous ovarian cancers, which account for 75 percent of cases. If a patient’s response to one targeted therapy diminishes, we have the ability to explore other options either through participation in a clinical trial or even through standard options, too.”

After three different regimens of chemotherapy proved ineffective for Janssen, she started looking for targeted therapy clinical trials. That search led her to Dana-Farber, where she eventually participated in a trial and received a combination of olaparib, a PARP inhibitor, and cediranib, an anti-angiogenesis inhibitor that blocks the epidermal growth factor receptor (EGFR).

The oral medication was easy to take. Janssen was more daunted by the logistics of traveling from Wisconsin to Boston every week for 10 weeks—but only at first. “People ask, ‘How do you manage that?’” she says. “You just put one foot in front of the other and figure things out.” The fact that she experienced few side effects from the medication helped, too.

As Janssen progressed to monthly monitoring, CT scans showed that her fingernail-sized tumors remained stable. She resumed her normal activities: Visiting her grandchildren in Texas, attending her church study groups, sewing hats for needy school children, and spending time with friends and family. She even tackled a lifelong goal of public speaking and started giving talks to medical students.

“Cancer can be a kick in the gut, but it also can be a kick in the pants,” she says. “It forces you to get in the fight, to choose the things you really want to do—and do them.”

After a year and a half, Janssen’s tumors showed some growth. The Dana-Farber team immediately switched her into a different trial for an infusion targeted therapy drug called IMGN-853. “That pipeline of new treatments is key,” Janssen said.

“My quality of life while on the trials has been so great that I currently feel like I may even lick this,” she says.

In the meanwhile, she has been given the precious gift of time. “The targeted therapies make it so easy to just live your life,” she says. “I’m probably not going to go into remission, but thanks to the trials I am keeping myself alive while researchers develop more miracle drugs that I’ll have access to later.”

To read this entire article by Dana Farber Cancer Institute, please click here.

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Letrozole Promising As Maintenance Treatment for High-Grade Serous Ovarian Cancer

Letrozole Promising As Maintenance Treatment for High-Grade Serous Ovarian CancerMaintenance therapy with an aromatase inhibitor may improve progression-free survival in women with estrogen receptor (ER)–positive, high-grade serous ovarian cancers, results of a non-randomized, single-center study suggest.

The benefit of letrozole maintenance treatment was also apparent in women with residual disease who received bevacizumab maintenance treatment, wrote first author Viola Heinzelmann-Schwarz, MD, of the Gynecological Cancer Center, University of Basel, Switzerland, and her coauthors.

The results “strongly suggest that endocrine maintenance therapy has more advantage than disadvantage for use in ovarian cancer patients and seems clearly justified,” when considered alongside other data regarding the potential benefit of letrozole in other treatment settings, Dr. Heinzelmann-Schwarz and her colleagues said.

“In contrast to available expensive maintenance medications like antiangiogenic [drugs] and PARP inhibitors, antihormonal drugs have a favorable safety profile, low cost, easy intake regimen with one tablet daily and an established prognostic target,” they added.

While the role of aromatase inhibitor maintenance therapy in high-grade serous ovarian cancer is unclear, previous studies have shown that patients with low-grade serous ovarian cancer may benefit from endocrine therapy.

Those studies in low-grade serous ovarian cancer include several small case series, and one retrospective analysis showing improved progression-free survival among women treated with endocrine therapy versus women who received observation only (J Clin Oncol. 2017 Apr. doi: 10.1200/JCO.2016.71.0632).

The more recent report by Dr. Heinzelmann-Schwarz and her colleagues included 50 women with ER-positive, FIGO (Fédération Internationale de Gynécologie et d’Obstétrique) stage III/IV high-grade serous ovarian cancer who were offered off-label letrozole treatment after debulking surgery and platinum-based chemotherapy. Twenty-three received letrozole maintenance treatment, and 27 declined.

In the group of women who received letrozole maintenance treatment, 60% were recurrence free at 24 months, compared with 38.5% of patients in the observation group (P = .035).

“This positive effect could particularly be seen when the treatment was initiated within 3 months after the end of adjuvant chemotherapy,” Dr. Heinzelmann-Schwarz and her coauthors wrote.

Among women with residual disease who received maintenance bevacizumab in addition to letrozole, 87.5% were recurrence free at 12 months, compared with 20.8% of patients who received bevacizumab only, the investigators said.

Minor side effects such as hot flushes, fatigue, and bone pain led to discontinuation in two patients (6.4%), and no serious adverse effects were seen during treatment, according to investigators.

Almost half of all high-grade serous ovarian cancers express ER, according to results of separate retrospective analyses also described by Dr. Heinzelmann-Schwarz and her colleagues in Gynecologic Oncology. They found that ER expression was similar regardless of drug resistance status (platinum sensitive versus platinum resistant) or treatment setting (primary or recurrent).

Dr. Heinzelmann-Schwarz and colleagues declared no conflicts of interest.

To read this entire article by MDEdge.com, please click here.

Olympic Gymnast Shannon Miller Opens Up About Ovarian Cancer

Olympic Gymnast Shannon Miller Opens Up About Ovarian Cancer When Shannon Miller was 19, she became the most decorated Olympic gymnast in U.S. history. Now 40, Miller has gained a few more titles: health advocate, mother—and ovarian cancer survivor.

Miller recently partnered with pharmaceutical company Tesaro to promote the Our Way Forward campaign, which brings ovarian cancer patients, their loved ones and their doctors together to talk about the disease.

Here, Miller opens up about her cancer journey and makes the case for me time.

What was your experience with cancer?

I was diagnosed with ovarian cancer seven years ago at the age of 33. I wish I would have had more resources and more knowledge. I didn’t even know the signs and symptoms I was having were related to something this serious, things like bloating and stomachache and weight loss. Women have some of these symptoms every month, and I never attributed them to something worse. In fact, the day I went in to see my doctor, the day they found a softball-sized cyst on my left ovary, I told him that same appointment that I felt fine.

Why did you decide to join this campaign?

It’s been my mission since going through this journey to help others with stories of hope. Being able to partner with Tesaro on such an important program, Our Way Forward, is a great way to rethink how we talk about ovarian cancer and navigate not just the physical portion but also the emotional challenges of ovarian cancer. Over 22,000 women will be diagnosed in the U.S. with ovarian cancer, and many of them will be diagnosed at a late stage because there is not a specific test for ovarian cancer. And with a late-stage diagnosis of ovarian cancer comes a higher chance of recurrence. So even with the resources of diagnosis and treatment, you still have the post-treatment issues—that was significant part of my journey that I did not expect. I thought when chemo was over I could go back to normal, but that’s not the way it works. I had to learn how to conquer this new normal, and I think that’s what Our Way Forward does. It helps patients, their family and loved ones, their physicians deal with some of those issues that arise post-treatment as well as during.

How did life change after cancer?

My doctor told me it would take a good six months to a year to start feeling like myself again, and I thought, No worries, I’ll do it in three months. Then the last day of chemo came, and for weeks I did not feel any different. I was so completely nauseous. I had so much fatigue, and it’s not fatigue where you’re just tired or you’re being lazy. It’s fatigue where I felt like every limb weighs a thousand pounds. And sometimes I would lie in bed in the morning and it would be like 15 minutes just to figure out how to move my leg four inches to the right so I could start to get out of bed. Everyone’s journey is different, but for me that was very eye-opening. I don’t think I was able to open a bottle of water by myself for a year. It was trying to figure out this new normal and a new set of goals and to be okay with to taking time. It wasn’t about winning a gold medal, it was about competing for a life. That’s where it really helped to reach out to people and to find those stories of hope and find those people that have been through this so that I could learn from them and feel less alone in the process.

How do you think your background as an athlete affected the way you looked at cancer?

The first phase was finding the cyst but not knowing it was cancer for several weeks. I think I felt like a victim and I just didn’t know how to move forward because I didn’t know what we were dealing with. But I think after surgery, finding out it was cancer and I was going to go through this chemotherapy treatment, I kind of reverted back to that competitive mentality. I think that’s where the lessons learned from sport really helped me. Lessons of goal-setting and perseverance and teamwork. I began to apply those to my treatment and then I kind of had to readjust as I was going through my post-treatment phase and understanding that my goals may be very different. I remember sometimes my goal was to get up and get dressed, and if I could walk twice around the dining room table, that was a really good day—it might as well have been wining a gold medal. And I think the other part of my cancer journey where I learned a lot was making every day count. Stopping and smelling the roses and understanding that today’s a good day because I’m here.

You’re also passionate about fitness and health. Do you have a wellness motto or outlook?

My diagnosis came about six months after I launched my company that’s devoted to women’s health, and our focus is helping women make their health a priority. Sometimes that’s through nutrition or fitness or getting enough me time, sleep. It is cancer awareness, diabetes, heart disease—really everything that affects our health and well-being. I get the fun opportunity to come at health from a lot of different angles. A lot of it revolves around awareness and education and really understanding that making our health a priority is not a selfish act. I know so many women—and I was one of them and sometimes I revert—focus on everyone and everything else that’s going on and then we forget to think about ourselves. And I try to say it’s a very selfless act because if you focus on your health, you get to be there fully for all of those who depend on you.

Read this article by Parade.com by clicking here.

Ovarian Cancer Patients’ Tissue Samples to be Tested for BRCA Gene Mutation

Thousands of women diagnosed with ovarian cancer will be tested to see if they are hidden carriers of the gene that can cause the deadly disease.

Ovarian Cancer Patients' Tissue Samples to be Tested for BRCA Gene MutationThe Traceback program at the Peter MacCallum Cancer Centre in Melbourne will test tissue samples of 11,000 women diagnosed between 2001 and 2016 to see if they are carriers of the BRCA gene mutations.

People with BRCA mutations are at an increased risk of breast, ovarian and prostate cancers.

Professor David Bowtell from the Peter MacCallum Cancer Centre said at least 1,500 of the women may have unknowingly inherited a BRCA mutation.

“BRCA1 and 2 mutations occur in up to 20 per cent of patients with ovarian cancer, particularly those with a serious type of the disease,” he said.

Before the Traceback program, there had been no active program in finding women who missed the opportunity to be tested for both mutations, experts said.

Sydney psychologist Kristin Young said if her family had been tested for the mutations, she might not have been diagnosed with ovarian cancer.

“My father had prostate cancer and his sister had breast cancer, so my oncologist suggested I should be tested for the BRCA mutations,” she said.

She discovered she had the BRCA2 mutation.

“Being able to go back and test these patients samples is fantastic, as this is the kind of research that will prevent other people from developing cancer,” she said.

Ms Young now has regular screenings and is taking a targeted cancer therapy, which is keeping her well.

Health Minister Greg Hunt said the Federal Government would give $3 million to the project.

“Approximately 1,500 Australian women were diagnosed with ovarian cancer last year and it’s estimated that more than 1,000 died,” he said.

“The results of this project will help women understand their risk of developing ovarian and breast cancer and allow them to consider taking preventative action.”

To read this entire article by ABC.net.au, please click here.

Using Anger as a Tool for Survival

By: Annette McElhiney

Using Anger as a Tool for SurvivalAs a devoted reader of the The New York Times, I find some peace (beside the national news and editorials) that captures my attention and imagination. Recently, they were both jolted by the piece, “I Used to Insist I Didn’t Get Angry. Not Anymore.” by Leslie Jamison.

As a 9.5 year ovarian cancer survivor and advocate, I frequently interact with other cancer patients who have just been diagnosed or are recurring. We often share the feelings we have had that people who don’t have cancer simply don’t understand. Two feelings most of us had, or still have, are profound sadness and anger. Most people expect and respect our sadness but our anger, not so much. So after reading this article, I began questioning the value of these emotions in a cancer survivor’s fight for survival.

Leslie Jamison writes, “The phenomenon of female anger has often been turned against itself, the figure of the angry woman reframed as threat — not the one who has been harmed, but the one bent on harming. She conjures a lineage of threatening archetypes: the harpy and her talons, the witch and her spells, the medusa and her writhing locks. The notion that female anger is unnatural or destructive is learned young; children report perceiving displays of anger as more acceptable from boys than from girls. According to a review of studies of gender and anger written in 2000 by Ann M. Kring, a psychology professor at the University of California, Berkeley, men and women self-report “anger episodes” with comparable degrees of frequency, but women report experiencing more shame and embarrassment in their aftermath. People are more likely to use words like “bitchy” and “hostile” to describe female anger, while male anger is more likely to be described as “strong.”

When I got my diagnosis of IIIC ovarian cancer in 2008, I was sad and as were my family and friends. Crying was to be expected and we did plenty of that. What I didn’t feel comfortable expressing was the rage I felt at being dealt such a blow when I’d  done everything I could to prevent it. From the time I was 20, I always had annual pelvic exams, I had my first child at 23, I breast fed my children, and I never took post menopausal hormones. Those were all deliberate acts that the textbooks of the time said should have protected me from ovarian cancer. What went wrong? I couldn’t stop thinking about other women who hadn’t done any of these things but still didn’t have cancer. Frankly, I felt I’d gotten a raw deal.

Because I didn’t want to be perceived as “feeling sorry for myself,” I stuffed my anger and became stoic. Yet in my head I was still angry and stoicism took its own toll.

Every ovarian cancer patient or survivor learns early that if she wants to survive, she will have to formulate a plan to get herself through the after effects of surgery and chemotherapy.

Even though Jamison wasn’t talking about the anger that comes with cancer, she came to the same conclusion.  She writes, “Confronting my own aversion to anger asked me to shift from seeing it simply as an emotion to be felt, and toward understanding it as a tool to be used: part of a well-stocked arsenal.” I also had to put my anger in my tool belt, to use it to energize my healing and to help me move forward.

Within 24 hours after my surgery, I asked my surgeon about my prognosis. He said I had a 25% to 35%chance of living 5 years. I was terrified, but at the same time I resisted his prediction. In my head, I kept thinking, “how dare he measure my life in such negative terms!” I determined that I’d be my own statistic! So without ever really realizing I was doing it, I set out to prove my doctor wrong.

My chemotherapy sessions were in my surgeon’s office and I chose a station where he would have to see me every time he went in and out of an examination room. Somehow, instinctively, I knew that in order to stoke my anger, I needed a constant reminder of my resolution to prove him wrong.

After I completed 8 sessions of chemotherapy, I had to find another outlet to keep my anger alive and fueling my recovery. I was too embarrassed to complain or admit my anger out loud, I had to find an acceptable way to express it. As an amateur painter and writer, I found throwing paint on a canvas helped. Eventually, I created a character (an alter ego of sorts), Althea — who could express my anger in a way I couldn’t. She was brash, confrontational, and uninhibited. When asked how I felt I’d always politely say “I’m fine.” Not Althea. Instead she’d say “I feel like HELL so just stay out of my way!”

While this strategy may not be for everyone, it worked for me as I used my anger as an energizing tool for recovery.

Jamison eloquently describes how to use anger as a source when she writes, “Once upon a time/I had enough anger in me to crack crystal’ the poet Kiki Petrosino writes in her 2011 poem  ‘At the Teahouse.” I boiled up from bed/in my enormous nightdress, with my lungs full of burning/chrysanthemums.’ This is a vision of anger as fuel and fire, as a powerful inoculation against passivity, as strange but holy milk suckled from the wolf. This anger is more like an itch than a wound. It demands that something happen.” 

I have been extremely fortunate because my cancer has not recurred. The further away I get from diagnosis, the more I draw upon my anger to propel my advocacy for other ovarian cancers survivors. I’m angry about a disease that affects the lives of so many women, both young and old, in every country and from every race. I’m also angry that ovarian cancer, as a woman’s disease only, is given far less research money than those diseases that affect both men and women.

My mother always said, “the squeaky wheel gets the grease.” So perhaps it’s time women use their anger as fuel to convert the high mortality rate of ovarian cancer patients to a much lower one. I am and will continue to be “a squeaky wheel” and I hope you will join me.

Sex After Cancer

By: Susan Gubar

Sex After CancerAt diagnosis, quite a few cancer patients spy Eros rushing out the door. I know I did. For some, eroticism vanishes during or after treatment. Anhedonia, the inability to feel pleasure, can afflict both men and women with cancer. We often get more help from one another than from the medical specialists who are beginning to address this challenge.

It can be difficult to experience desire if you don’t love but fear your body or if you cannot recognize it as your own. Surgical scars, lost body parts and hair, chemically induced fatigue, radiological burns, nausea, hormone-blocking medications, numbness from neuropathies, weight gain or loss, and anxiety hardly function as aphrodisiacs. At 46, the youngest member of my cancer support group put it best: “an existential crisis is not sexy.” Although her physicians offered no advice, she eventually attempted to foster a renewed sex life, if only for the caring partner who saw her through treatment.

“Sex and Cancer,” a new book by Dr. Saketh R. Guntupalli, a gynecologic cancer specialist, and Maryann Karinch, sets out to help women with gynecologic or breast cancer. Dr. Guntupalli and Ms. Karinch labor mightily to provide scientific evidence for an insight some might consider predictable: “We found that sex was less pleasurable for women after cancer and that all types of sexual activity — oral, vaginal and anal — decreased after cancer.” In patches of ponderous prose, their book describes the ways in which treatment inhibits romance.

More informative are the sections of “Sex and Cancer” in which the authors explain what people can do to ensure that “the emperor of all maladies” will not rule and wreck their relationships. First and foremost, Dr. Guntupalli and Ms. Karinch urge readers not to “slap a ‘dysfunction’ label on your love life just because you read something about what is ‘normal’ or ‘average.’” This is precisely the advice that prostate cancer patients also receive in self-help manuals.

The capacious term “sex” should not be conflated with penetration or intercourse, according to Dr. Guntupalli and Ms. Karinch. “There is no dysfunction if both members of the couple are happy with the level and style of intimacy they enjoy.” Kissing, hand-holding, cuddling, caressing and massaging bond couples by kindling arousal and ardor. The authors do not mention the useful word “frottage” which comes from the French for rubbing or friction; it neatly bundles together many forms of stimulation that prompt tenderness and excitement.

With a therapist or on their own, partners can try “sensate focus exercises” that involve them in exploratory touching without the pressure to achieve a goal like orgasm. Pelvic floor exercises, vibrators, techniques for dealing with scar tissue and restricted range of motion, dilators as well as lubricants: Dr. Guntupalli and Ms. Karinch tackle these specifics to encourage survivors to redefine sex after cancer as a sensual source of delight in a range of activities.

To illustrate this point, they tell the story of Allis, a 49-year-old ovarian cancer patient who undergoes “a total pelvic exenteration” (the surgical removal of the bladder, urethra, rectum, anus, vagina and cervix). She awakens with a permanent colostomy and a urinary diversion. She must wear two bags to collect feces and urine. To her dismay, gone are her cute thongs, replaced by granny panties. She buys an ostomy belt (to protect and hide the bags) as well as a black negligee.

But she sobs when her husband’s embraces bring home the realization that there is “no way to have normal sex.” After he reassures her that they can be creative, they begin getting ideas by visiting what she calls “naughty stores” and then exploring every possible way to enjoy themselves together.

Not facing such extreme physiological impairments, the youngest member of my support group nevertheless found herself “less easily aroused and less orgasmic.” Her explanation of how she cultivated “the art of desire” strikes me as illuminating for women and also for men.

She uses exercise to appreciate her body’s tremendous resilience; acknowledges that she is anatomically, psychologically and hormonally changed; experiments with solo sex and also extended foreplay with her partner; and samples the shared stimulation of movies, concerts and travels to create a sense of closeness. Since her marital bed had been her sick bed, she refurbished the bedroom with sensory stimulants. It now promotes joy in her partner’s life and in hers as well.

When Eros disappears, books and conversations can help couples prepare to welcome the god’s return. As the poet Marianne Moore once put it, in an entirely different context, “Whatever the problem, we must elude the sense of being trapped — even if all one can say to one’s self is, ‘if not now, later.’” For many people, better later than never.

Yet this is not the case for everyone, I realized when my contemporary and fellow academic Nancy K. Miller responded to my request for input on the issue of sex after cancer. In her 70s, she has, like me, managed the disease for years. With precisely the exasperation I associate with the intimacy I crave, she shot back, “You expect me to remember sex?” My laughter was a total turn on, as I bathed in the bliss of cherishing my friend’s candor.

To read this article by Susan Gubar in The New York Times, please click here.

Addition of Hyperthermic Intraperitoneal Chemotherapy to Cytoreductive Surgery in Advanced Ovarian Cancer

Addition of Hyperthermic Intraperitoneal Chemotherapy to Cytoreductive Surgery in Advanced Ovarian CancerIn a Dutch/Belgian phase III trial reported in The New England Journal of Medicine by van Driel et al, the addition of hyperthermic intraperitoneal chemotherapy to interval cytoreductive surgery following neoadjuvant chemotherapy was associated with significantly improved recurrence-free and overall survival in patients with newly diagnosed advanced epithelial ovarian cancer.

Study Details

In the open-label trial, 245 women with stage III disease from 8 sites in the Netherlands and Belgium were randomized between April 2007 and April 2016 to undergo interval cytoreductive surgery with (n = 122) or without (n = 123) hyperthermic intraperitoneal chemotherapy with cisplatin at 100 mg/m2. Patients had to have at least stable disease after three cycles of carboplatin (AUC = 5–6 mg/mL/min) and paclitaxel (175 mg/m2).

Randomization was performed at the time of surgery for cases in which it was believed surgery would result in no visible disease (complete cytoreduction) or in one or more residual tumors measuring ≤ 10 mm in diameter (optimal cytoreduction). Randomization was stratified by previous surgery, hospital in which surgery was performed, and number of involved regions in the abdominal cavity (0–5 vs 6–8). Patients received three additional cycles of carboplatin and paclitaxel after surgery.

The primary endpoint was recurrence-free survival in the intent-to-treat population. The minimum number of events required for recurrence-free survival analysis was reached in April 2016, and efficacy data were updated in March 2017.

In the hyperthermic intraperitoneal chemotherapy vs control groups: the median age was 61 vs 63 years; histology was high-grade serous in 92% vs 87%; 10% in both groups had received prior surgery; the number of regions affected at the start of cytoreductive surgery was 0 to 5 in 68% vs 67%; residual disease after surgery was R-1 in 69% vs 67%, R-2a in 18% vs 20%, and R-2b in 11% in both; 76% in both had no bowel resection; median duration of surgery was 338 vs 192 minutes; median duration of hospitalization was 10 vs 8 days; median time between surgery and the start of adjuvant chemotherapy was 33 vs 30 days; and 94% vs 90% completed 3 cycles of adjuvant chemotherapy. Among patients who underwent bowel resection, colostomy or ileostomy was more common in the hyperthermic intraperitoneal chemotherapy group (21 of 29 patients = 72%) vs the control group (13 of 30 patients = 43%; P = .04).

Efficacy Outcomes

The median follow-up at the time of recurrence-free survival analysis was 4.7 years. Recurrence-free survival events occurred in 81% of the hyperthermic intraperitoneal chemotherapy group vs 89% of the control group; median recurrence-free survival was 14.2 months vs 10.7 months, respectively (hazard ratio [HR] = 0.66. P = .003). The benefit of hyperthermic intraperitoneal chemotherapy was consistent across stratification factors and post hoc subgroups.

Hazard ratios (none reaching statistical significance) were 0.63 and 0.72 for those aged ≥ 65 and < 65 years; 0.69 and 0.56 for those with high-grade serous and other histology; 0.71 and 0.47 for those with no previous surgery and previous surgery; 0.64 and 0.66 for those with 0 to 5 and 6 to 8 involved regions; and 0.69 and 0.61 for those with no laparoscopy vs laparoscopy before surgery. Death occurred in 50% of the hyperthermic intraperitoneal chemotherapy group vs 62% of the control group; median overall survival was 45.7 vs 33.9 months (HR = 0.67, P = .02).

Adverse Events

No significant differences between the hyperthermic intraperitoneal chemotherapy and control groups were observed in the incidence of adverse events of any grade. The most common adverse events of any grade in the hyperthermic intraperitoneal chemotherapy group were nausea (63% vs 57%), abdominal pain (60% vs 57%), and fatigue (37% vs 30%).

Grade ≥ 3 adverse events occurred in 27% vs 25% of patients (P = .76). The most common grade 3 or 4 adverse events in the hyperthermic intraperitoneal chemotherapy group were infection (6% vs 2%), abdominal pain (5% vs 6%), and ileus (4% vs 2%). One patient in the control group died within 30 days after surgery.

The investigators concluded:Among patients with stage III epithelial ovarian cancer, the addition of [hyperthermic intraperitoneal chemotherapy] to interval cytoreductive surgery resulted in longer recurrence-free survival and overall survival than surgery alone and did not result in higher rates of side effects.”

To read this full article on The ASCO Post, please click here.