Intraperitoneal treatment and dose-intense therapy in ovarian cancer

Background: There has been a longstanding controversy regarding the role of high-dose chemotherapy in patients with advanced ovarian cancer. Based on retrospective studies, it has been suggested that there will be improved results when doses of platinum compounds in particular are increased. High-dose therapy can be administered using an intraperitoneal route of drug delivery or with haematologic support in the form of autologous bone marrow transplantation (ABMT) or peripheral blood stem cell transfusions (PBSCT). Methods: Experienced clinical investigators reviewed published data available on high-dose chemotherapy and intraperitoneal drug delivery. In addition, ongoing clinical trials of ABMT or PBSCT were also reviewed. Results: Prospective randomised trials have failed to demonstrate that doubling the dose of platinum compounds increases survival in patients with advanced ovarian cancer. Intraperitoneal chemotherapy with cisplatin or paclitaxel remains an area of investigation and prospective randomised trials in previously untreated patients as well as part of consolidation therapy in patients achieving a complete remission are in progress. Phase II trials of high-dose chemotherapy with ABMT or PBSCT in previously treated patients with advanced ovarian cancer have produced higher response rates than achieved with conventional doses although there has been no proven impact upon survival. Prospective randomised trials in previously untreated patients are in progress. Until the completion of these trials, high-dose chemotherapy with ABMT or PBSCT and intraperitoneal chemotherapy should be considered investigational.