Intraperitoneal Therapy of Ovarian Cancer

Abstract

PURPOSE: This is a review of the rationale for the intraperitoneal administration of antineoplastic agents in the management of ovarian cancer. PATIENTS AND METHODS: Patients have been treated in a number of clinical trials to define the toxicity profile and efficacy of intraperitoneal therapy in this clinical setting. RESULTS: Phase I-II trials have confirmed that a number of cytotoxic and biological agents can be administered into the peritoneal cavity as treatment of ovarian cancer with an acceptable toxicity profile and with the attainment of surgically documented responses (including complete responses). In addition, a recently reported phase III trial comparing initial treatment of small-volume residual advanced ovarian cancer with either intravenous or intraperitoneal cisplatin concluded that the intraperitoneal route of drug administration was associated with a longer survival and less toxicity. DISCUSSION: In the salvage (second-line) setting, responses to intraperitoneally administered antineoplastic agents are seen principally in individuals with small-volume residual disease (largest tumor mass </= 0.5-1 cm in maximum diameter) who have previously responded to initial systemic treatment (i.e., documented chemosensitive cancers). Patients with cancers resistant to initial systemic chemotherapy or with larger tumor bulk should probably be treated by alternative strategies. Initial treatment of ovarian cancer with cisplatin delivered by the intraperitoneal route is a reasonable therapeutic option, based on currently available data. CONCLUSION: The intraperitoneal delivery of antineoplastic agents remains an interesting and potentially important management strategy for a select group of individuals (small-volume residual disease) with advanced ovarian cancer. Further exploration of a more defined role for this therapeutic approach in ovarian cancer is indicated