The clinical setting and pharmacology of intraperitoneal chemotherapy: an overview

Intraperitoneal chemotherapy first arose in response to unrelated studies introducing such concepts as the presence of a peritoneal diffusion barrier that acted to slow the systemic release of the drug and the incidence of small miliary nodules remaining on the peritoneal surface after initial clinical response. These minimum residual disease patients were considered the best clinical group for early study of intraperitoneal therapy. The problem of access to the peritoneal cavity was solved with the Tenckhoff catheter, which had previously been used for whole peritoneal dialysis in nephrology patients. There was also some concern about drug distribution, but a radiologic visualization technique was developed that revealed distribution to be satisfactory in most patients. Systemic delivery of the study drug was not shown to be compromised by intraperitoneal administration of 5-fluorouracil, an agent that has advantageous activity for ovarian cancer therapy. Cisplatin, however, was generally considered the most efficacious drug for treatment of this disease, although it has not yet been extensively studied. Intraperitoneal chemotherapy is currently attracting a great deal of attention, and its potential applications are many.