Intraperitoneal chemotherapy in patients with advanced ovarian cancer: the con view.
OBJECTIVE
In this paper we wish to present the reasons why i.p. chemotherapy cannot be accepted as standard of care for first-line systemic treatment of advanced ovarian carcinoma.


METHODS
The recent literature on i.p. chemotherapy is critically reviewed. All possible arguments against i.p. chemotherapy are reviewed.


CONCLUSIONS
Intraperitoneal chemotherapy is associated with a higher toxicity rate than i.v. chemotherapy. For this reason, none of the regimens investigated in the three Gynecologic Oncology Group (GOG) studies can be used as standard treatment outside clinical protocols. The trials on i.p. chemotherapy have suggested a survival difference. However, in the two most recent trials, i.p. chemotherapy or not was not the only research question because different schedules and dosages were used. In addition, the significance of the most recent GOG 172 study was only weak (p = .03), and the result was nonsignificant for progression-free survival. Intraperitoneal chemotherapy should be used only in the context of properly designed clinical trials. These trials must either assess i.p. therapy in comparison with the standard treatment or address the issue of route of administration for equivalent dosages and schedules of the same drugs, and not a mosaic of these questions. In addition, these trials should investigate i.p. regimens that are less toxic than the regimens used in the three GOG trials, and which can be combined with molecular targeted therapies.
Vergote
Ignace
I
Department of Gynaecological Oncology, Division Obstetrics & Gynaecology, UZ-Leuven, Herestraat 49, 3000 Leuven, Belgium. Ignace.Vergote@uz.kuleuven.ac.be
Amant
Frederic
F
Leunen
Karin
K
Cadron
Isabelle
I
Van Gorp
Toon
T
Neven
Patrick
P
Berteloot
Patrick
P
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral / Q000009:adverse effects; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D011788:Quality of Life; D012107:Research Design; D016896:Treatment Outcome