Proceedings of a GOG workshop on intraperitoneal therapy for ovarian cancer

Abstract

Ovarian cancer is the leading cause of gynecologic cancer deaths in the U.S. The concept of intraperitoneal drug delivery for therapy of intraperitoneal cancers, such as ovarian cancer, arose in the 1960s. The field of intraperitoneal cisplatin therapy for ovarian cancer was initiated in the late 1970s and early 1980s. The markedly improved survival data resulting from a third phase III trial of intraperitoneal cisplatin for ovarian cancer in early 2006 led to an NCI Clinical Announcement and a Gynecologic Oncology Group-sponsored workshop on Intraperitoneal Therapy in January, 2006, in San Diego, California. The proceedings of this workshop summarize both research trial results and practical implementation issues associated with intraperitoneal therapy discussed at this workshop.

Why have ovarian cancer mortality rates declined? Part II. Case-fatality

“…The conventional rationale for intraperitoneal chemotherapy is that drugs clear the peritoneal cavity slowly, allowing for the drugs to achieve concentrations 20-to 1000-fold higher than typically achieved with intravenous chemotherapy regimens, with low systemic exposure [44,45]. An alternate theory is that the intraperitoneal administration affects the mesothelium such that it no longer readily supports tumor growth [46]. The penetration of intraperitoneal chemotherapy is limited to 1 to 2 mm of the tumor surface; therefore, the survival benefit of intraperitoneal chemotherapy is expected to accrue to patients with no (or little) residual disease.…”

Clinical trials and progress with paclitaxel in ovarian cancer

“…The added day 8 paclitaxel regimen introduces another set of variables in addition to the mode of delivery of the therapy. Some argue that the results seen with GOG 172 are not significantly better than what can be achieved with the IV carboplatin and three-hour paclitaxel regimens 110–112. It is noteworthy that neutropenia, gastrointestinal toxicity, fatigue, pain, and metabolic events were increased in the IP arm.…”

Scavenger Receptor-A–Targeted Leukocyte Depletion Inhibits Peritoneal Ovarian Tumor Progression

“…treatments for ovarian cancer (34) and, indeed, the National Cancer Institute now encourages i.p. delivery of therapy for clinical treatment of ovarian cancer (35). Weekly injections of anti-SR-A immunotoxin were sufficient to deplete tumor-recruited peritoneal VLCs, to inhibit ascites accumulation, and, most importantly, this resulted in decreased tumor burden.…”