IP Chemotherapy, Combination Therapy For Cervical Cancer And IVF Treatment For Infertility

Main Category: Cancer / Oncology
Also Included In: Fertility;  Women's Health / Gynecology;  Clinical Trials / Drug Trials
Article Date: 17 Oct 2006 - 0:00 PDT

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At the 11th biennial meeting of the International Gynecologic Cancer Society (IGCS) underway in Santa Monica, CA, results from three international studies have implications for physicians and women in the United States.

In a study, "Intraperitoneal Chemotherapy Improves Survival and Disease- Free Interval from Ovarian Cancer: A Meta-Analysis of Randomized trials," Drs. K.S. Jaaback and N. Johnson from the Royal United Hospital, Bath, UK, working on behalf of the Cochrane Collaboration, found that women who received a combination of intraperitoneal chemotherapy and chemotherapy given by vein were 20% less likely to die of their cancer and lived on average 9 months longer than women who only received chemotherapy by vein.

Women with ovarian cancer who receive some of their chemotherapy directly in the abdominal cavity live longer than women who only receive intravenous (IV) chemotherapy, according to a meta-analysis of eight randomized trials. Ovarian cancer is the leading cause of gynecologic cancer deaths in the United States and other developed countries around the world. As yet, there is no effective screening test or combination of tests for ovarian cancer. In 2006, the American Cancer Society has estimated that over 20,000 women will be diagnosed with ovarian cancer and over 12,000 will die of ovarian cancer.

"This analysis supports the Clinical Announcement made by the U.S. National Cancer Institute in January, 2006," commented Dr. William Hoskins, director of the Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center Savannah, GA, former Chief of Gynecologic Oncology, Memorial Sloan-Kettering Cancer Center, and vice-president of the IGCS. "It emphasizes the importance of effective primary surgery for ovarian cancer to remove as many cancer cells as possible, followed by the best possible chemotherapy, which combines IV and IP approaches. The next challenge is to ensure that all women with ovarian cancer have access to the best multi- disciplinary care, which includes surgery, chemotherapy and effective symptom control."

In a study addressing the role of combination chemotherapy and radiation therapy in the treatment of cervical cancer, Drs. Claire Vale and Jayne Tierney of the United Kingdom Medical Research Council found that women who received chemotherapy at the same time as radiation had a 24% decrease in the risk of death.

The study, "Concomitant Chemoradiation for Cervical Cancer: A Meta- Analysis Using Individual Patient Data from Randomized Controlled Trials," evaluated 15 randomized clinical trials involving 4,254 women. "We tracked down the doctors who conducted these studies around the world," explained Dr. Tierney. "They agreed to share data from each woman with cervical cancer who participated in these 15 trials. We found that the 24% decrease in the risk of death holds up for all women with cervical cancer regardless of the stage of the disease or the chemotherapy regimen used."

Dr. Gillian Thomas, professor of radiation oncology at the University of Toronto and immediate past president of the IGCS commented, "These are impressive results. In 1999 the U.S. National Cancer Institute issued a Clinical Announcement on the basis of five trials conducted in North America, recommending that women get both radiation and chemotherapy with platinum at the same time. Now we have data from around the world which says exactly the same thing."

Cervical cancer is the second leading cause of cancer deaths among women worldwide. The World Health Organization has estimated that each year over 500,000 women will be diagnosed with cervical cancer and over 300,000 women will die of cervical cancer. In its earliest stages, cervical cancer may be treated with surgery, which may include removal of a portion of the cervix or hysterectomy. At more advanced stages, definitive treatment consists of radiation therapy, often given at the same time as chemotherapy.

"We believe that the chemotherapy helps sensitize cancer cells to the radiation, as well as potentially killing any cancer cells which might have spread elsewhere in the body," explained Dr. Thomas. "Radiation given with chemotherapy should definitely be the new standard of care."

For women considering in vitro fertilization (IVF) treatment for infertility, a study, "Risk of Hormone-Related Cancers after Ovarian Stimulation for In Vitro Fertilization in a Cohort of 26, 428 Women," reported mixed results.

Dr. Charles Burger of Erasmus University Medical Center in Rotterdam and a team of Dutch researchers found that IVF treatment for infertility does not increase a women's risk of developing breast cancer, but does slightly increase a women's risk of ovarian cancer.

The risk of cancer among 18,298 women who had undergone at least one IVF treatment for infertility was compared to 6,230 women with subfertility who did not undergo IVF. They found no difference in the risk of breast cancer among the two groups of women. They did observe a dramatically increased risk of benign ovarian tumors, so called "borderline ovarian tumors," among women who underwent IVF treatments, as well as slightly increased risk of ovarian cancer. In addition, both groups of women had an increased risk of endometrial cancer, most likely explained by subfertility. Pregnancy and breast feeding are known to protect against the development of endometrial cancer.

"These findings provide guidance to women who are considering IVF therapy for infertility and their doctors," commented Dr. Michael Friedlander, professor of medical oncology at the University of New South Wales in Australia and the current president of the IGCS. "We know that pregnancy and breast feeding can protect a woman against breast and ovarian cancer. In the past, we had worried that the relatively high doses of hormones and multiple ovulations associated with IVF might increase a women's risk for breast and ovarian cancer, both of which are hormonally related. The great weight of evidence now suggests that IVF does not increase a women's risk of breast cancer later in life. We do need, however, to counsel women about their slightly increased risk of ovarian and endometrial cancer."

The International Gynecologic Cancer Society is a not-for-profit professional society with 1200 members from 80 countries dedicated to reducing the global burden of women's cancers through education and research. IGCS meetings are held every two years, rotating between the Americas, Asia, and Europe/ Africa. Additional information on the IGCS may be found at http://www.igcs.org; additional information on the scientific program for the 11th biennial IGCS meeting may be found at http://www.kenes.com/igcs-11.

International Gynecologic Cancer Society
http://www.igcs.org