Intraperitoneal therapy for ovarian cancer: why has it not become standard?

T hree randomized, controlled trials have demonstrated substantial improvements in overall survival for patients with advanced ovarian cancer who received chemotherapy via the intraperito-neal (IP) route — injected directly into the peritoneal cavity — compared with those who received it intravenously. Moreover, the National Cancer Institute has recommended that intraperitoneal treatment to be the standard of care. But according to those who treat ovarian cancer, only about half of the physicians in the field have accepted the technique. Toxic effects, technical complications with the procedure, and concerns about study designs have all contributed to the lack of acceptance. And, as these phase III trials were under way, the drugs used to treat ovarian cancer evolved: paclitaxel replaced cyclophosphamide; carboplatin replaced cisplatin; and now, new targeted agents such as bevacizumab are being eyed for possible additions to current regimens. Some physicians point to studies showing that patients may live more than a year longer if given intraperitoneal instead of intravenous treatments and express frustration that the technique is not more widely accepted. Others point to evolving drug regimens and say that the data are insuffi cient to support such acceptance. " Even though the NCI suggested that intraperitoneal therapy be the standard of care, and even though we have three phase III trials, there are enough questions about effi cacy and toxicity " to explain the split within the academic community, said