Review: Advances in Intraperitoneal (Intracavitary) Administration of Synthetic Polymers for Immunotherapy and Chemotherapy

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Abstract
Intraperitoneal (IP) catheters linked to subcutaneous portals have made routine intracavitary chemotherapy or immunotherapy safe and convenient. The IP route is anatomically appropriate for adjuvant or palliative treatment of intracavitary disease. IP chemotherapy has been successfully applied to ovarian, mesothelial, and gastrointestinal tumors. Data shows that IP divinyl ether/maleic anhydride copolymer. MVE-2 (MW 15,000), has distinct localizing and toxicologic differences from that given intravenously (IV). When MVE-2 is given IV renal injury is observed; this is not seen on IP administration. The highest IP concentrations are found in mediastinal and mesenteric nodes, thymus and testis while the highest IV MVE-2 accumulation is found in the liver, spleen, adrenal, and kidney. The IP route for treatment of tumors allows for high local tumoricidal drug concentrations or for regionalized immunostimulation with activating polymers or leukokines. The IP space can provide an antitumor, and antiviral immunizing site and/or a source of activated antitumor peritoneal exudate cells. The use of IP chemotherapy readily permits systemic neutralization of drug toxicity and can provide high portal venous concentrations of drug for the treatment of early liver metastasis. This review speaks to the convenience and safety of the IP intracavitary route which provides a new option for the clinical utilization of polymers where regionalized abdominal effects and improved therapeutic index are warranted. The biologic application of IP polymers requires polymer distribution and kinetic studies which will provide unique tissue concentrations for application to immunization, cancer treatment and other diseases.