A revolutionary new way of delivering chemotherapy, 1,000 times stronger than normal, offers hope to women battling ovarian cancer.
The anti-cancer drugs are put directly into the abdomen, via a catheter, instead of being injected into the bloodstream using an intravenous drip.
A trial of the new technique, known as intraperitoneal chemotherapy, has just been launched across the UK from Barts and The London School of Medicine.
The new chemotherapy treatment put directly into the abdomen is 1,000 times stronger than normal and gives hope to ovarian cancer sufferers.
Ovarian cancer is one of the deadliest forms of the disease. Every year, 6,600 women are diagnosed and 4,300 will die from it. But Dr Chris Gallagher, who heads the study in the UK, is confident this advance will show an increase in survival of around 20 per cent.
He said: ‘Ovarian cancer tends to spread, or recur, within the abdominal cavity. It is unusual for it to spread to other parts of the body – in that way, it’s different from many other cancers.
‘By giving the treatment directly into the area where the cancer is located, we have the potential to expose the tumour to much higher concentrations of the drug.
‘We need to increase the efficacy of chemotherapy drugs against ovarian cancer, so we won’t be able to reduce the dose. But increasing their intensity will get a better response.’
Hitting the tumour harder could also reduce its ability to become resistant to chemotherapy drugs, a common problem with ovarian cancer. Because more cancer cells are destroyed in each dose of chemotherapy, there are fewer left with the opportunity to evolve and develop ways of surviving the treatment.
The PETROC study, a joint UKCanadian trial, will recruit 150 women newly diagnosed with advanced ovarian cancer. It will compare the effect of identical doses of two conventional chemotherapy drugs – paclitaxel plus either carboplatin or cisplatin, which are both forms of platinum – when given directly into the abdomen or intravenously.
Platinum is widely used in the treatment of cancer, often in combination with other drugs. It works by binding to tumour cell genes.
Dr Gallagher said: ‘Earlier studies indicate that when given directly the platinum-based drug is about 10 times more concentrated and the paclitaxel is about 1,000 times higher than when given intravenously.
‘As both drugs are then absorbed into the bloodstream, the sideeffects such as nausea, tiredness and hair loss are similar.’
During the treatment, a small catheter is inserted into the abdomen during surgery or under local anaesthetic.
Each course of chemotherapy takes around six hours – slightly longer than conventional treatment.
Afterwards, most women experience temporary abdominal swelling.
Dr Gallagher hopes this new trial will identify the patients most likely to benefit and resolve any worries about catheters causing pain. In previous studies around 5 per cent found the method too painful.
Ovarian cancer has been called the ‘silent killer’, as it is often so advanced by the time it is diagnosed that two out of three women will not survive. Just 4 per cent of women are confident they could spot the signs of the disease, according to a poll carried out last week.
Symptoms, which include pelvic and abdominal pain, bloating and difficulty eating, can be confused with Irritable Bowel Syndrome.
Professor Iain McNeish, a specialist at Barts and The London Hospital, often sees patients who were initially told they had a gastric rather than gynaecological problem.
He does not blame doctors, as most GPs will only ever see three or four cases of ovarian cancer.
But he said: ‘For IBS to appear for the first time in a woman in her 50s, or older, is very rare. If a woman regularly gets these symptoms, she should see her GP and ask them to rule out ovarian cancer.’
In most cases, it won’t be a tumour, but if it is ovarian cancer, early diagnosis is the key, says Professor McNeish.
‘The single strongest predictor of survival is how advanced your cancer is at the time of diagnosis.
‘We hope that intraperitoneal chemotherapy will give women with advanced ovarian cancer a better chance of beating the disease in the long term.’
Jane Symons – 2nd March 2010