Intraperitoneal paclitaxel in the management of ovarian cancer

For several reasons, including its demonstrated activity in ovarian cancer, large size, hepatic metabolism, and lack of vesicant properties, paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) is an interesting agent to consider for intraperitoneal administration in the management of ovarian cancer. Two phase I trials have confirmed a major pharmacokinetic advantage (> or = 1,000-fold) for peritoneal cavity exposure compared with the systemic compartment following intraperitoneal delivery of paclitaxel. A Gynecologic Oncology Group phase II trial of second-line intraperitoneal paclitaxel in ovarian cancer patients is currently in progress to determine whether the high concentrations and prolonged duration of exposure to paclitaxel of the surface of the peritoneal cavity can be translated into increased tumor cell kill and objective responses in this clinical setting. Future development of this novel therapeutic strategy will depend on the results of this important clinical trial.