A pilot phase I trial of continuous hyperthermic peritoneal perfusion withhigh-dose carboplatin as primary treatment of patients with small-volume residual ovarian cancer

Purpose: Because intraperitoneal (i.p.) therapy may provide a therapeutic a dvantage and because hyperthermia enhances carboplatin (CBDCA) cytotoxicity , we evaluated the feasibility, toxicity, and pharmacokinetics of CBDCA giv en via continuous hyperthermic peritoneal perfusion (CHPP) in patients with small-volume residual ovarian cancer. Patients and Methods: Six patients u nderwent optimal cytoreductive procedures (residual disease less than or eq ual to 5 mm) as initial treatment of stages II and III epithelial ovarian a denocarcinoma. All patients received a 90-min CHPP at a CBDCA dose of 800-1 200 mg/m(2), with the perfusate being recirculated rapidly from a reservoir through a heat exchanger, resulting in i.p. temperatures of 41-43 degrees C. Plasma, perfusate, and urine samples were collected and platinum was qua ntified by flameless atomic absorption spectrophotometry. Results: At no ti me did any patient's core temperature exceed 40 degrees C. Peak perfusate p latinum concentrations were 8- to 15-fold higher than peak ultrafilterable plasma concentrations. The permeability-area product was extremely high and variable (14-90 ml/min), resulting in a regional advantage of 1.9-5.3. The percentage of the dose absorbed ranged widely from 27% to 77%. Dose-limiti ng hematologic toxicity was observed at a dose of 1200 mg/m(2) and this was associated with a CBDCA AUC in plasma of 11 mg min ml(-1) Conclusions: CHP P with CBDCA was safely given to three patients at a dose of 800 mg/m(2), a nd dose-limiting hematologic toxicities observed at 1200 mg/m(2) correlated with the plasma CBDCA exposure established when lower doses of CBDCA are g iven systemically. The pharmacokinetic data are consistent with the expecte d effect of vigorous mixing on the exposed peritoneal surface area. Variabl e drug absorption and clearance make the prediction of systemic exposure hi ghly uncertain. These findings may have important implications for novel th erapies given i.p.