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Current status of intraperitoneal therapy for ovarian cancer
1Department of Hepatology/Medical Oncology, Cleveland Clinic Foundation, OH 44195.
Abstract:
Recent attention has focused on evaluating those clinical situations in which intraperitoneal drug delivery may be an appropriate treatment option for patients with ovarian cancer. When employed as a second-line strategy, approximately 20% to 30% of patients with small-volume residual disease (microscopic, largest tumor mass < or = 0.5 to 1 cm in maximum diameter) at initiation of treatment are expected to achieve a surgically documented complete response with a variety of organoplatinum-based intraperitoneal regimens. However, responses are rarely observed in such patients who have failed to demonstrate tumor sensitivity to systemically delivered organoplatinum drugs, despite the presence of small-volume residual disease. Investigators at several centers are currently exploring a possible role for regional drug delivery in the initial management of selected patients (ie, small-volume disease) with ovarian cancer. A recently reported trial of intraperitoneal taxol suggests this may be an ideal drug for regional therapy of ovarian cancer due to a major pharmacokinetic advantage associated with this route of drug delivery.
Insights
Intraperitoneal chemotherapy offers a 20-30% response rate for ovarian cancer patients with small tumors. Taxol shows promise for regional therapy due to its pharmacokinetic advantages.
Area of Science:
- Oncology
- Pharmacology
- Surgical Oncology
Background:
- Intraperitoneal (IP) chemotherapy is being evaluated for ovarian cancer treatment.
- Second-line IP therapy with organoplatinum drugs yields responses in 20-30% of patients with small-volume residual disease.
- Tumor sensitivity to systemic organoplatinum drugs is crucial for successful IP treatment.
Purpose of the Study:
- To explore the role of regional drug delivery in ovarian cancer management.
- To identify optimal drug candidates for IP therapy.
Main Methods:
- Review of clinical situations for IP drug delivery in ovarian cancer.
- Analysis of treatment outcomes for patients with small-volume residual disease.
- Evaluation of a trial using intraperitoneal taxol for regional therapy.
Main Results:
- Approximately 20-30% of patients with small-volume residual disease achieve complete response with IP organoplatinum regimens.
- Patients resistant to systemic organoplatinum drugs rarely respond to IP therapy.
- Intraperitoneal taxol demonstrates pharmacokinetic advantages for ovarian cancer regional therapy.
Conclusions:
- IP chemotherapy is a viable option for selected ovarian cancer patients with small-volume residual disease.
- Taxol is a promising agent for IP regional therapy in ovarian cancer due to favorable pharmacokinetics.