Intraperitoneal versus intravenous cisplatin-based therapy in small-volume residual refractory ovarian cancer: Evidence supporting an advantage for local drug delivery

Intraperitoneal (i.p.) chemotherapy employing a cisplatin-based regimen has recently been introduced as a treatment strategy for patients with refractory ovarian cancer. However, in the absence of randomized trials, it is uncertain whether a higher response rate will be observed following i.p. cisplatin-based treatment compared to continued intravenous (i.v.) cisplatin-based therapy in this clinical setting. A retrospective review of the medical literature revealed several trials where patients with small-volume refractory ovarian cancer were treated either i.v. (three trials) or i.p. (five trials) cisplatin-based therapy and then subjected to surgical evaluation to define a response. Overall, 3/35 patients (9%) treated with i.v. treatment and 33/122 patients (27%) treated with i.p. treatment achieved a surgically defined (laparotomy or laparoscopy) complete response (P < 0.025). This assessment of non-randomized trials suggests that there may be a relative clinical advantage when patients with small-volume residual refractory ovarian cancer are treated with i.p. cisplatin-based therapy compared to continued systemic drug treatment with a cisplatin-based regimen.