Intraperitoneal paclitaxel: a possible role in the management of ovarian cancer?

Intraperitoneal paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has been examined for a potential role in the management of ovarian cancer based on its (I) documented activity in ovarian cancer, (2) cycle-specific cytotoxicity, (3) large molecule, (4) at least partial metabolism in the liver, and (5) nonvesicant properties. Phase I evaluation has confirmed that the drug can be delivered safely intraperitoneally, with a major (> or = 3 log) pharmacokinetic advantage for peritoneal cavity exposure over that of the systemic compartment. Phase II and, ultimately, randomized phase III trials will be required to determine whether the tremendous pharmacokinetic advantage associated with regional delivery of paclitaxel can be translated into improved outcomes for women with advanced, but small-volume residual, ovarian cancer.