Clinical Efficacy Supporting the Role of Intraperitoneal Drug Delivery in the Primary Chemotherapeutic Management of Small-Volume Residual Advanced Ovarian Cancer

Delivery of chemotherapeutic agents directly into the peritoneum to treat tumors localized to the abdominal cavity is a concept tested initially in clinical practice in the early 1950s. However, thorough investigation of the drawbacks and potential of intraperitoneal (IP) drug administration was not explored until the late 1970s. After fading in popularity, three major phase III randomized trials (SWOG 8501/GOG 104, GOG 114, and GOG 172) have helped IP therapy to resurface as an acceptable alternative for selected stage III ovarian cancer patients with optimally debulked tumors. These trials have provided overwhelming evidence supporting the value of IP strategy in prolonging progression-free and overall survival rates. GOG 172 showed a remarkable 15.9 month increase in median overall survival for the IP arm in comparison to the intravenous arm. This review article discusses the clinical data available from these three Gynecologic Oncology Group (GOG) studies (SWOG 8501/GOG 104, GOG 114, and GOG 172), supporting the use of a combination of IP and intravenous chemotherapy in patients with stage III ovarian cancer after surgical debulking.