Pharmacologic principles of intraperitoneal chemotherapy for the treatment of ovarian cancer.

Intraperitoneal therapy has now been demonstrated in multiple randomized trials to improve the outcome of chemotherapy for patients with optimally debulked or small volume ovarian carcinoma. This article reviews the basic pharmacologic principles that underlie the use of intraperitoneal therapy and identifies the key factors that determine the pharmacologic advantage of this route of administration. These include the relative peritoneal and plasma clearances and elements of tumor vascular permeability and blood flow that limit the penetration of drug entering tumor nodules by free-surface diffusion. New information about how cisplatin and carboplatin are transported into ovarian carcinoma cells points to novel strategies for further improving the therapeutic effectiveness of intraperitoneal chemotherapy.