Pharmacodynamic aspects of intraperitoneal cytotoxic therapy.

摘要: The rationale for ip administration as an adjunct to surgery is firmly based on theoretical and pharmacokinetic grounds. superiority of combined intravenous chemotherapy over alone has been established in randomized trials stage IIIc ovarian cancer patients. Intraoperative cytotoxic therapy results a definite pharmacological advantage, since high peritoneal concentrations are achieved with limited systemic absorption. At present, however, it not clearly what extent this PK advantage will result enhanced anticancer activity and, ultimately, survival benefit. Preclinical models show that direct penetration into tumour tissue few millimeters. Furthermore, the exposure time intraoperative chemoperfusion could limit despite local concentrations. Among agents currently used, pharmacodynamic aspects platinum compounds best studied both without associated hyperthermia. Newer such taxanes camptothecins appear promising during or immediately after surgery. Pharmacodynamic HIPEC needing further preclinical study-including mathematical modeling - establishment newer its relation hyperthermia, definition relative contribution versus vascular supply by absorbed drug, efficacy regimens. Ultimately, randomised have provide evidence base build upon.