Intraperitoneal carboplatin-based chemotherapy for epithelial ovarian cancer

Objective. Intraperitoneal (IP) chemotherapy is an attractive approach to the treatment of ovarian cancer because the disease remains confined to the peritoneal cavity for a large part of its natural history. In this review article, we discuss the current status and future perspectives of IP chemotherapy for ovarian cancer. Methods. A systematic review of IP carboplatin-based chemotherapy for ovarian cancer treatment was conducted through evaluation of published manuscripts as well as abstracts from the proceedings of the American Society of Clinical Oncology and the Society of Gynecologic Oncologists. Results. Despite the fact that survival or progression-free survival benefit has been demonstrated by three large randomized trials (Survival Hazard Ratio for GOG104/SWOG 0.76, Relative Risk Reduction of Progression: 0.78 for GOG114, and 0.73 for GOG172), IP chemotherapy has not been accepted as a standard treatment. This appears to be mainly due to the cisplatin-related toxicity and IP catheter failure. Substituting cisplatin with carboplatin may make this approach more tolerable. Recent pharmacological data suggest that carboplatin-based IP chemotherapy not only exposes the peritoneal cavity to higher doses of the agent, but also attains levels of systemic platinum comparable to intravenous (IV) administration. A large retrospective study has demonstrated excellent survival for patients with advanced ovarian cancer who underwent carboplatin-based IP chemotherapy. Low observed toxicity as well as infrequent catheter-related complications was significant findings in this report. Conclusion. A large scale phase III randomized trial is now urgently needed to clarify the role of carboplatin-based IP chemotherapy in ovarian cancer.