Principles and practice of intraperitoneal chemotherapy for ovarian cancer

Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Saitama, Japan
International Journal of Gynecological Cancer (Impact Factor: 1.96). 01/2007; 17(1):1-20. DOI: 10.1111/j.1525-1438.2007.00809.x
Source: PubMed


Intraperitoneal (IP) chemotherapy has been studied for years to improve the survival of patients with ovarian cancer. Recently, the result of Gynecologic Oncology Group 172 trial comparing IP versus intravenous administration of cisplatin-based chemotherapy was published, demonstrating the improvement of survival benefit in favor of the IP arm. This trial is the third trial that showed a survival benefit on IP chemotherapy. The National Cancer Institute (NCI) and Gynecologic Oncology Group have done a meta-analysis on the results of these three US trials and other phase III trials of IP versus intravenous chemotherapy, and significant improvement of survival was shown with IP therapy. Based on this meta-analysis, NCI has released a clinical announcement encouraging the gynecological oncology community to consider IP chemotherapy as the standard treatment for optimally debulked advanced ovarian cancer patients. However, there still are controversial issues regarding the use of IP chemotherapy. It is important to understand how IP chemotherapy works to solve those issues in the future. In this review article, we discuss the principles and clinical aspects of IP chemotherapy and also discuss the current problems and future perspectives in IP chemotherapy.

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    • "In addition, different parameters must be considered to select the ideal chemotherapeutic agent for IP therapy and to maximize its efficacy: cavity-to-plasma AUC ratio, systemic absorption, depth of tumor penetration, and intrinsic activity of the agent against the primary tumor type. In general, water insoluble molecules with a high molecular weight and a high cavity-to-plasma AUC ratio remain longer in the peritoneal cavity and are thus preferred for IP treatment (Table 1) [23, 24]. One important consideration is that a high cavity-to-plasma AUC ratio does not automatically confer a higher efficacy, since penetration of the chemotherapeutic agent into the tumor might be limited. "
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    • "Despite recent improvements, the prognosis of patients with peritoneal carcinomatosis from digestive or ovarian origin treated with systemic chemotherapy remains poor [1,2]. Intraperitoneal chemotherapy (IPC) improves the control of regional disease in ovarian cancer and increases survival in carcinomatosis of colorectal origin [3,4]. Trials have shown a survival benefit with post-operative IPC versus intravenous administration of cisplatin-based chemotherapy in ovarian cancer [5,6]. "
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