A trial comparing different combinations of chemotherapy after surgery for advanced ovarian, primary peritoneal or ovarian cancer (PETROC/OV21)

Cancer type:

Ovarian cancer

Status:

Results

Phase:

Phase 2

This trial looked at giving carboplatin and paclitaxel chemotherapy in different ways to women who have had chemotherapy before surgery. It was for women with:

These cancers are all treated in the same way, so when we use the term ovarian cancer in this summary, we are referring to all 3.

Cancer Research UK supported this trial.

More about this trial

Surgery followed by chemotherapy is the usual treatment for ovarian cancer. If the cancer has spread outside the ovary it can be difficult for the surgeon to remove. So you might also have chemotherapy before surgery.

Chemotherapy before surgery is called neoadjuvant chemotherapy. It might shrink the cancer so it is easier to remove. This is called interval debulking surgery. You then have more chemotherapy.

When this trial was done, doctors weren’t sure of the best way to give the chemotherapy after surgery. The usual way is to have it as a drip into a vein.

Some research suggested that giving some chemotherapy as a drip and some directly into the tummy (abdomen) might be better to help stop the cancer coming back. Chemotherapy into the abdomen is called intra peritoneal chemotherapy.

In this trial, some women had chemotherapy into the abdomen and as a drip into a vein and some had it only as a drip into a vein.

The aims of the trial were to:

find out if chemotherapy into the tummy (abdomen) helps women with ovarian cancer who have already had chemotherapy before surgery
learn more about the side effects
find out if treatment affected quality of life

Summary of results

The researchers published the results in 2018. The trial team found that having part of the treatment into the abdomen helped some women in this trial.

Treatment
Everyone who took part had already had chemotherapy followed by surgery.

The trial was in 2 stages. Stage 1 looked at 3 different ways of having chemotherapy to find out which worked best.

These were giving:

paclitaxel and carboplatin as a drip into the vein (group 1)
paclitaxel as a drip into the vein and cisplatin and paclitaxel through a tube into the abdomen (group 2)
paclitaxel through a drip into a vein and carboplatin and paclitaxel through a tube into the abdomen (group 3)

When the trial team looked at the results, they found that giving carboplatin and paclitaxel worked best.

Stage 2 looked at which way of giving these drugs worked best. Women were put into 1 of 2 treatment groups at random.

101 women had paclitaxel and carboplatin as a drip into a vein (group 1)
102 women had paclitaxel through a drip into a vein and carboplatin and paclitaxel through a tube into their abdomen (group 3)

Women in both groups had treatment in 3 week periods called cycles of treatment. They had up to 3 cycles.

Results
9 months after treatment, the trial team looked whose cancer had got worse (this is called progressive disease). They found this was in just over:

4 out of 10 women (42.2%) in group 1
2 out of 10 women (23.3%) in group 3

study diagram

They also looked at:

how long before the cancer started to grow again – this is called progression free survival
how long people lived for after treatment – this is called overall survival
quality of life

But there weren’t enough women taking part in the trial. So it wasn’t possible to measure the differences between group 1 or 3.

Quality of life
The researchers didn't find any differences in quality of life between the groups.

Side effects
Women who had all their treatment as a drip into a vein had more serious side effects. These included:

a drop in blood cells causing an increased risk of infection
tummy (abdominal) pain

Conclusion
The trial team concluded that having carboplatin and paclitaxel into the abdomen and as a drip was well tolerated. They say it is a treatment option to consider for women who have already had chemotherapy followed by surgery. They are continuing to study tissue samples from women who took part in the trial to see if they can see who would benefit most from having this type of treatment.

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item ) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.