Intraperitoneal chemotherapy of ovarian cancer

Ovarian cancer is the leading cause of death among cancers of the female reproductive tract. Most women present with regionally advanced intraperitoneal disease with superficial spread of tumor along the peritoneal surfaces. Distant metastasis rarely occurs until late in the disease process; however, long-term survival of patients with advanced disease remains poor. Intraperitoneal chemotherapy allows higher concentration and prolonged half-life of chemotherapy within the peritoneal cavity compared with intravenous administration, while therapeutic intravenous concentrations are obtained. Three large randomized Phase III trials and a meta-analysis have firmly established the superiority of combination intraperitoneal and intravenous chemotherapy compared with intravenous chemotherapy alone in women with optimally debulked advanced epithelial ovarian carcinoma. In January of 2006, the National Cancer Institute issued a clinical alert recommending that these women receive a combination of intravenous and intraperitoneal chemotherapy; however, resistance to adopt this as a new standard of care results from concerns regarding toxicity and lack of experience with intraperitoneal catheters. Here we review the largest trials of combination intraperitoneal and intravenous chemotherapy, address the concerns regarding intraperitoneal chemotherapy, and provide further resources for implementing intraperitoneal chemotherapy into practice.