Intraperitoneal delivery of chemotherapeutic agents for the treatment of peritoneal metastases: current challenges and how to overcome them

Introduction: Peritoneal metastases of cancer remain a major cause of an adverse outcome and death following surgical treatment of malignancies that occur within the abdomen and pelvis. The administration of a chemotherapy solution directly into the peritoneal space has been used to improve the survival in this group of patients. Areas covered: Relevant manuscripts from my own publications and identified through Medline and PubMed were reviewed if they concerned neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), hyperthermic intraperitoneal chemotherapy (HIPEC), early postoperative intraperitoneal chemotherapy (EPIC), normothermic intraperitoneal chemotherapy (NIPEC). The pharmacologic information that will impact on the efficacy of intraperitoneal chemotherapy administration was also reviewed. Expert opinion: The four major technologies for obtaining peritoneal access of cancer chemotherapy to peritoneal metastases were studied. The differences in distribution of chemotherapy solution, in selection of chemotherapy agents to be delivered, and variations in delivery systems were presented and critically analyzed. The most obvious benefits of combined cytoreductive surgery and intraperitoneal chemotherapy have been demonstrated with appendiceal mucinous neoplasms and malignant peritoneal mesothelioma. Continued efforts with new intraperitoneal chemotherapy agents and methods of drug delivery continue for ovarian cancer, colorectal cancer, and gastric cancer.