Intraperitoneal Chemotherapy for Epithelial Ovarian Cancer

Patient Selection and Treatment Regimen

The National Comprehensive Cancer Network recommends paclitaxel 135 mg/m² IV continuous infusion over 24 hours on day 1, followed by cisplatin 75-100 mg/m² IP on day 2, and paclitaxel 60 mg/m² IP on day 8, repeated every 3 weeks for 6 cycles, for optimally debulked stage III epithelial ovarian cancer 1, 2, 3
This regimen is specifically indicated for stage III epithelial ovarian cancer with optimal debulking (<1 cm residual disease) 2, 4, 5
The American College of Obstetricians and Gynecologists and the National Comprehensive Cancer Network suggest that stage II disease may also be considered, though randomized evidence is lacking 2, 3

The IP regimen demonstrated a 16-month overall survival advantage over standard IV therapy (65.6 vs 49.7 months; P = .03) in the GOG-172 trial 2, 3, 4
The IP paclitaxel/cisplatin regimen is associated with leukopenia and infection, fatigue, renal toxicity, abdominal discomfort and pain, neurotoxicity, nausea/vomiting/dehydration, and catheter complications 1, 2, 7, 9

Aggressive hydration is mandatory to prevent renal toxicity, with patients often requiring outpatient IV fluids for 5-7 days after each cycle 1, 2, 5, 6
Only 42% of patients completed all 6 cycles in initial studies due to toxicity, with common reasons for discontinuation including catheter complications, abdominal pain, nausea/vomiting/dehydration, and abdominal discomfort 1, 2, 7
If patients cannot complete IP therapy, switching to IV chemotherapy with paclitaxel 175 mg/m² IV over 3 hours followed by carboplatin AUC 5-7.5 IV every 3 weeks is recommended 1, 2, 7

The NCCN downgraded IP chemotherapy to Category 2A ("useful in certain circumstances") in their 2020 guidelines, reflecting ongoing controversy about its use 6, 9
ESMO guidelines consider IP therapy experimental and recommend its use only in clinical trials 10
The regimen requires significant institutional experience and infrastructure for optimal outcomes, and whether to use IP versus IV chemotherapy remains controversial despite survival data 1, 6, 7