Maximizing the delivery of intraperitoneal therapy while minimizing drug toxicity and maintaining quality of life

This decade has witnessed three large randomized trials (SWOG 8501/GOG 104, GOG 114, and GOG 172) clearly showing the advantages of intraperitoneal (IP) chemotherapy over systemic/intravenous therapy in treating selected patients with advanced stage ovarian cancer. Despite showing an impressive increase in median progression-free survival and median overall survival, complications in IP chemotherapy delivery and drug-related toxicities reported in these studies have hindered widespread acceptance and implementation of first-line IP therapy. Some of these complications and drug-related toxicities are treatment-limiting and need special attention. Success of IP therapy as a first-line choice of treatment is dependent upon ideal patient selection, effective delivery of appropriate doses of chemotherapy agents to the tumor site, and efficient management of complications. With proper orientation and instruction in IP catheter placement and patient management, these obstacles can be overcome, allowing for successful administration of IP therapies. This review article discusses clinical approaches to maximize the delivery of IP therapy while minimizing catheter complications. Mitigating drug toxicities with the use of cytoprotectants such as amifostine and preventing infection with the use of agents, such as amifostine and pegfilgrastim, are discussed in detail.