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Treatment Name: Intraperitoneal (IP) Cisplatin + IP Pacli­taxel + Intra­venous (IV) Pacli­taxel

Intraperitoneal (IP) Cisplatin + IP Pacli­taxel + Intra­venous (IV) Pacli­taxel is a Chemotherapy Regimen for Ovarian Cancer

How does this IP cisplatin + IP paclitaxel + Intravenous (I.V.) paclitaxel work?
Each of the medications in this regimen are designed to enter inside and then kill ovarian cancer cells. Intraperitoneal (I.P) chemotherapy is given into the abdominal cavity as a way to increase chemotherapy exposure to ovarian cancer cells.

Goals of therapy:
I.P. cisplatin + I.P. paclitaxel + I.V. paclitaxel is given to kill any remaining tumor cells after debulking surgery is performed to remove cancer tissue from the abdomen. Depending upon the stage of cancer and the success of surgery, I.P. cisplatin + I.P. paclitaxel + I.V. paclitaxel may be given with the goal of cure. Women who have no detectable ovarian cancer after surgery or cancer less than 1 cm in size have been shown to benefit most from this treatment, when compared to women who have residual tumors greater than 1 cm in size.

Schedule

  • Paclitaxel continuous intravenous (I.V.) infusion over 24 hours on Day 1, ending Day 2
  • Cisplatin intraperitoneal (I.P.) infusion given rapidly via gravity (no pump) on Day 2
  • Paclitaxel intraperitoneal (I.P.) infusion given rapidly via gravity (no pump) on Day 8
    • Approximately 1 to 2 hours is spent lying down after intraperitoneal chemotherapy is infused. During this time you will be asked to reposition your body approximately every 15 minutes. This is done to help disperse the chemotherapy throughout the peritoneal space

Estimated total infusion time for this treatment:

  • Up to 24 hours for Day 1 of each cycle
  • Intraperitoneal infusion time on Day 2 and Day 8 can vary. It can take as short at 30 minutes and as long as 2 to 3 hours to infuse
  • Typically, I.V. hydration is given both before and after cisplatin and can add up to two hours
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

I.P. cisplatin + I.P. paclitaxel + I.V. paclitaxel is usually given in an outpatient infusion center, allowing the person to go home afterwards.

I.P. cisplatin + I.P. paclitaxel + I.V. paclitaxel is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to six times, depending upon the stage of the disease. Duration of therapy may last up to six months, depending upon response, tolerability, and number of cycles prescribed.

Click here for the common I.P. cisplatin + I.P. paclitaxel + I.V. paclitaxel starting doses.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported IP cisplatin + IP paclitaxel + IV paclitaxel side effects are shown here:

Although the exact incidence is not reported in clinical trials, abdominal pain, abdominal discomfort, nausea, with or without vomiting are common side effects of intraperitoneal chemotherapy.

On average, 17% of patients discontinue the intravenous treatment and 58% of patients discontinue the intraperitoneal treatment due to unacceptable side effects or problems with the intraperitoneal catheter (port).

Side effect videos Side Effect Videos
Fatigue Fatigue PainPainNausea and VomitingNausea and VomitingAnemiaAnemiaConstipationConstipationDiarrheaDiarrhea

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), CA-125 (a tumor marker for ovarian cancer), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before starting treatment and after finishing treatment. Imaging may also be checked during treatment at the discretion of your doctor. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue IP cisplatin + IP paclitaxel + IV paclitaxel as planned, delay treatment, or switch therapy.

ChemoExperts Tips

  • It is important to urinate just prior to the intraperitoneal infusion so that you don’t have to urinate during the infusion and risk moving the port needle
  • Paclitaxel may cause infusion reactions when used as an I.V. formulation. Patients may receive several medications prior to receiving paclitaxel (this is known as "pre-medication") to decrease the risk of infusion reactions. Common pre-medications given are a histamine-2 blockers such as famotidine (Pepcid®) or ranitidine (Zantac®), a histamine-1 blocker such as diphenhydramine (Benadryl®), and a corticosteroid such as dexamethasone
  • Notify your nurse if are experiencing any discomfort during the intraperitoneal infusions. The speed of the infusion may need to be slowed down or you may need to be repositioned
  • Chemotherapy administered into the intraperitoneal space does not need to be drained. Your body will absorb the fluid and remove it naturally
  • A port is typically required for administration of intraperitoneal chemotherapy. Only chemotherapy and associated I.V. fluids should be administered through this device and not any other medications. On occasion, the port can be placed during the same surgical procedure to remove the ovarian cancer
  • To minimize discomfort when the port is accessed, a numbing cream (local anesthetic known as EMLA cream) may be prescribed
  • Notify your doctor if you notice redness, swelling, or tenderness around the port site as these could be signs of a possible infection of the device
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for ovarian cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications.

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Intraperitoneal (IP) Cisplatin + IP Pacli­taxel + Intra­venous (IV) Pacli­taxel, we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Intraperitoneal (IP) Cisplatin + IP Pacli­taxel + Intra­venous (IV) Pacli­taxel. Depending upon your income, they may be able to help cover the cost of:

  • Cisplatin
  • Paclitaxel

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Intraperitoneal (IP) Cisplatin + IP Pacli­taxel + Intra­venous (IV) Pacli­taxel and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Intraperitoneal (IP) Cisplatin + IP Pacli­taxel + Intra­venous (IV) Pacli­taxel

Individual Drug Label Information

Cisplatin (Platinol®)

  • Cisplatin is an intravenous (I.V.) infusion that is typically given over one to two hours
  • Cumulative toxicity to kidneys from cisplatin can be severe 
  • Other toxicities from multiple doses are:  low blood counts, nausea, vomiting, and hearing loss
  • Dosage adjustments may be required for poor kidney function or bone marrow toxicity (low blood counts) 
  • Cisplatin is hazardous to a human fetus; women should avoid pregnancy while on this drug 
  • Women should not breast-feed while on cisplatin; it has been reported to be in human milk 
  • Patients on anticonvulsant drugs may have decreased levels while on cisplatin 
General Cisplatin (Platinol) Side Effects 
  • Kidney problems (nephrotoxicity), especially in elderly patients. 
  • Nausea and vomiting, both acute (within first 24 hours) and delayed (two to five days after infusion) 
  • Diarrhea 
  • Low blood cell counts (myelotoxicity, acute leukemia)
  • Hearing problems- ringing ears.  All patients should have a baseline hearing test done.  All children should have hearing test done before each dose and for several years after therapy is complete 
  • Low blood electrolytes:  magnesium, potassium, calcium, sodium, and phosphate
  • Nerve pain 
  • Vision problems; improvement and/or complete recovery usually occurs after stopping therapy 
  • Liver toxicity; recovery usually occurs after stopping therapy 
  • Click on the cisplatin (Platinol) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Paclitaxel (Taxol®)

  • Paclitaxel is an intravenous infusion
  • There is a risk for serious infusion reactions such as trouble breathing, low blood pressure, severe swelling, or hives. These reactions are due to a component in the solution called Cremophor. You will receive several medications before receiving paclitaxel to decrease the risk of experiencing an infusion related reaction that include: a corticosteroid, diphenhydramine (Benadryl), and histamine-2 antagonists (Zantac or Pepcid).Patients who experience these type of severe reactions should not be rechallenged with paclitaxel.
  • This drug can cause low white blood cell counts. Complete blood counts (CBC) will be checked before each treatment to make sure your white blood cells are at a safe enough to use this drug
  • Dosage adjustments may be required for liver dysfunction, nerve pain or toxicity, low white blood cells, or low blood platelets
  • Nerve pain usually starts as tingling or a "pins and needles" feeling in the fingers or toes, but can worsen over time and lead to numbness. It is important to notify the doctor if there are any signs of nerve damage. If caught early, this is typically reversible but can become permanent if not addressed
  • Interacts with certain antifungal, blood pressure, cholesterol, erectile dysfunction, sedative, antibiotic, and anti-seizure medications.  Ask your doctor or pharmacist to review your medications for any possible interactions
  • Known interaction with grapefruit or grapefruit juice. Avoid eating grapefruit and drinking grapefruit juice as they may increase your risk of experiencing side effects
  • Avoid the natural supplement St. John’s Wort as this can possibly decrease the effectiveness of paclitaxel
  • Injection site skin reactions can occur:  itching, skin infection, skin falling off, skin death, and redness. Report any of these to your physician, even if this occurs several days after an infusion
  • Can cause fetal harm; this drug should not be used during pregnancy.  Women should avoid becoming pregnant while on this drug
General Paclitaxel (Taxol) Side Effects
  • Low blood neutrophil count (neutropenia)
  • Low white blood cells
  • Nerve pain and general pain
  • Low red blood cells and related fatigue
  • Infusion reactions - hypersensitivity
  • Hair loss
  • Nausea
  • Diarrhea
  • Mouth sores
  • Low blood pressure
  • Liver problems
  • Constipation
  • Fever and infection
  • Bleeding
  • Injection site reactions
  • Nail discoloration; usually reversible once paclitaxel is stopped
  • Click on the paclitaxel (Taxol) package insert below for all manufacturer reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingConstipationConstipationPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1) Armstrong DK, Bundy B, Wenzel L, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354:34-43.

2) Potter KL and Held-Warmkessel J. Intraperitoneal chemotherapy for women with ovarian cancer: nursing care and considerations. Clin J Oncol Nurs. 2008;12:265-271.

Created: February 21, 2017 Updated: February 21, 2017

What is Ovarian Cancer?

What is Ovarian Cancer?
A disease of the cells found in the ovaries in women. Ovarian cancer is not common, but is the fifth leading cause of cancer related death in women. The exact cause is not known, however risk factors include: older age, obesity, first period at an early age, late menopause, hormone replacement therapy (HRT) after menopause, family history, and genetic causes such as the BRCA (pronounced "bracka") mutation. The use of oral contraceptives or having one or more full-term pregnancies can decrease the risk of ovarian cancer.

The stage of ovarian cancer can vary at diagnosis and throughout treatment. Ovarian cancer is staged using the Tumor, Node, Metastasis (TNM) staging system, as well as Stage Grouping I, II, III, or IV. Staging systems describe the extent of cancer throughout the body and help doctors determine which treatments to offer. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Common I.P. cisplatin + I.P. paclitaxel + I.V. paclitaxel starting doses

  • Paclitaxel 135 mg/m2 continuous intravenous (I.V.) infusion over 24 hours on Day 1, ending Day 2
  • Cisplatin 100 mg/m2 intraperitoneal (I.P.) infusion given rapidly via gravity (no pump) on Day 2
  • Paclitaxel 60 mg/m2 intraperitoneal (I.P.) infusion given rapidly via gravity (no pump) on Day 8
    • Approximately 1 to 2 hours is spent lying down after intraperitoneal chemotherapy is infused. During this time you will be asked to reposition your body approximately every 15 minutes. This is done to help disperse the chemotherapy throughout the peritoneal space

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium