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Evidence-Based Research for Intraperitoneal Chemotherapy in Epithelial Ovarian Cancer

Lois Almadrones
CJON 2007, 11(2), 211-216 DOI: 10.1188/07.CJON.211-216

Intraperitoneal (IP) therapy is the administration of chemotherapy or biologic agents directly into the peritoneal cavity. A recent Gynecologic Oncology Group trial showed a survival advantage for women with advanced ovarian cancer and small residual disease after initial surgical staging and debulking who received IP therapy when compared to the standard IV regimen. The results prompted a National Cancer Institute announcement recommending the use of IP therapy in women who meet the criteria. This article describes the rationale for and underlying principles of IP therapy and summarizes the results of the three main clinical trials that led to the recommendation for incorporation of IP therapy into initial treatment of epithelial ovarian cancer.


Alberts, D.S., Liu, P.Y., Hannigan, E.V., O'Toole, R., Williams, S., Young, J.A., et al. (1996). Intraperitoneal cisplatin plus intravenous cyclophosphamide versus cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. <i>New England Journal of Medicine</i>, 335, 1950-1955.

Armstrong, D.K., Bundy, B., Wenzel, L., Huang, H.Q., Baergan, R., Lele, S., et al. (2006). Intraperitoneal cisplatin and paclitaxel in ovarian cancer. <i>New England Journal of Medicine</i>, 354, 34-43.

Bleyer, W.A., & Dedrick, R.L. (1977). Clinical pharmacology of intrathecal methotrexate. I. Pharmacokinetics in nontoxic patients after lumbar injection. <i>Cancer Treatment Reports</i>, 61, 703-708.

Dedrick, R.L. (1985). Theoretical and experimental bases of intraperitoneal chemotherapy. <i>Seminars in Oncology</i>, 12(3, Suppl. 4), 1-6.

Dedrick, R.L., Myers, C.E., Bungay, P.M., & DeVita, V.T., Jr. (1978). Pharmacokinetic rationale for peritoneal drug administration in the treatment of ovarian cancer. <i>Cancer Treatment Reports</i>, 62, 1-9.

Howell, S.B., Pfeifle, C.L., Wung, W.E., Olshen, R.A., Lucas, W.E., Yon, J.L., et al. (1982). Intraperitoneal cisplatin with systemic thiosulfate protection. <i>Annals of Internal Medicine</i>, 97, 845-851.

Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., & Thun, M. (2007). Cancer statistics, 2007. <i>CA: A Cancer Journal for Clinicians</i>, 57, 43-66.

Kraft, A.R., Tompkins, R.K., & Jesseh, J.E. (1968). Peritoneal electrolyte absorption: Analysis of portal, systemic venous and lymphatic transport. <i>Surgery</i>, 13, 219-242.

Markman, M., Bundy, B.N., Alberts, D.S., Fowler, J.M., Clark-Pearson, D.L., Carson, L.F., et al. (2001). Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage II ovarian carcinoma: An intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. <i>Journal of Clinical Oncology</i>, 19, 1001-1007.

Markman, M., Hakes, T., Reichman, B., Hoskins, W., Rubin, S., Jones, W., et al. (1989). Intraperitoneal therapy in the management of ovarian carcinoma. <i>Yale Journal of Biology and Medicine</i>, 62, 393-403.

Markman, M., Rowinsky, E., Hakes, T., Reichman, B., Jones, W., Lewis, J.L., Jr., et al. (1992). Phase I trial of intraperitoneal Taxol: A Gynecologic Oncology Group study. <i>Journal of Clinical Oncology</i>, 10, 1485-1491.

Markman, M., & Walker, J.L. (2006). Intraperitoneal chemotherapy of ovarian cancer: A review, with a focus on practical aspects of treatment. <i>Journal of Clinical Oncology</i>, 24, 988-994.

McGuire, W.P., Hoskins, W.J., Brady, M.F., Kucera, P.R., Partridge, E.E., Look, K.Y., et al. (1996). Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III ovarian cancer. <i>New England Journal of Medicine</i>, 334, 1-6.

Shapiro, W.R., Young, D.F., & Mehta, B.M. (1975). Methotrexate: Distribution in cerebrospinal fluid after intravenous, ventricular and lumbar injections. <i>New England Journal of Medicine</i>, 293, 161-166.