Intraperitoneal antineoplastic drug delivery: rationale and results

Area of Science:

• Oncology
• Pharmacology
• Surgical Oncology

Background:

• Intraperitoneal (IP) drug delivery aims to increase antineoplastic agent exposure to peritoneal tumors, potentially enhancing cytotoxicity.
• Phase I studies demonstrated pharmacokinetic advantages and safety of IP administration for drugs like cisplatin and paclitaxel.

Purpose of the Study:

• To review the efficacy and safety of intraperitoneal chemotherapy for malignant disease within the peritoneal cavity.
• To evaluate the role of IP drug delivery in ovarian cancer and other peritoneal malignancies.

Main Methods:

• Review of Phase I, II, and randomized clinical trials investigating intraperitoneal chemotherapy.
• Analysis of drug concentrations, response rates, and survival data from published studies.

Main Results:

• Phase I studies confirmed higher drug concentrations (cisplatin 10x, paclitaxel 1000x) with IP delivery compared to systemic.
• Phase II trials in ovarian cancer showed potential for complete responses with second-line IP cisplatin.
• Randomized trials demonstrated a survival advantage for first-line IP chemotherapy in advanced ovarian cancer with small-volume residual disease.

Conclusions:

• First-line intraperitoneal chemotherapy after cytoreduction improves survival in advanced ovarian cancer.
• Current evidence does not support IP drug delivery for non-ovarian peritoneal malignancies outside clinical trials.