Intraperitoneal chemotherapy: Belly-bath or pain-in-the-side?

Abstract

THE ARTICLE published by Canal et al. in the European Journal of Cancer and Clinical Oncology demonstrates the pharmacologic and clinical utility of administering the epipodophyllotoxin, VM-26, in the peritoneal cavity [ 11. When given to mice bearing the Krebs II ascitic tumor, the pharmacologic advantage for this drug is 15-30 compared to intravenous (i.v.) administration. Furthermore, at the higher dose levels mice could be cured of their intraperitoneal tumors when given the drug by the intraperitoneal (i.p.), but not the iv. route. If this experience is verified in humans, it will be possible to add VM-26 to the growing list of chemotherapy drugs which can safely be administered by the i.p. route. Interest i.p. drug administration has been renewed since the late 1970s when it became evident that combination chemotherapy could frequently cause clinical complete remissions in ovarian cancer, but at “second-look” laparotomy many of these patients had residual microscopic disease. Previously, chemotherapy had been administered in the peritoneal cavity to patients with ascites in an attempt to cause sclerosis. In the 197Os, with advances in peritoneal dialysis for renal failure, better understanding of membranedialysis physiology, and development of indwelling peritoneal catheters, interest turned to i.p. drug administration as a kind of “reverse” dialysis. Dedrick and co-workers at the American National Cancer Institute proposed a model of i.p. drug administration in large volumes to ensure homo-