Sugarbaker Paul H
Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, DC, USA.
J Gastrointest Oncol. 2021 Apr;12(Suppl 1):S231-S239. doi: 10.21037/jgo-2020-03.
Paclitaxel administered into the peritoneal cavity is a chemotherapy agent that shows unusually prolonged retention within the peritoneal space. Using this pharmacokinetic fact as a starting point, the use of this drug to benefit patients with peritoneal metastases was investigated. The pharmacokinetics and drug characteristics of paclitaxel were identified from the oncologic literature. The experience to date with ovarian cancer, malignant peritoneal mesothelioma, gastric cancer and pancreas cancer was explored. Paclitaxel given by repeated instillation through an intraperitoneal port has demonstrable responses in ovarian cancer, peritoneal mesothelioma, gastric cancer and pancreas cancer when peritoneal metastases are present. Its role for prevention of peritoneal metastases in patients at high risk seems less well established. Randomized controlled studies have been positive in ovarian cancer but not in other diseases with peritoneal dissemination. A randomized controlled study in gastric cancer with peritoneal metastases produced suggestive but not conclusive results. Conversion surgery after repeated treatments with intraperitoneal paclitaxel has been reported with gastric cancer and pancreas cancer with peritoneal metastases. The pharmacology of intraperitoneal paclitaxel strongly suggest that intraperitoneal administration should be of benefit to prevent or treat peritoneal metastases. Protocols that the oncologist can follow to realize these potential benefits are not as yet available.
腹腔内注射的紫杉醇是一种化疗药物，在腹腔内的滞留时间异常延长。以此药代动力学事实为出发点，对使用该药物治疗腹膜转移患者的情况进行了研究。紫杉醇的药代动力学和药物特性是从肿瘤学文献中确定的。探讨了目前在卵巢癌、恶性腹膜间皮瘤、胃癌和胰腺癌方面的经验。当存在腹膜转移时，通过腹腔端口反复滴注给予紫杉醇，在卵巢癌、腹膜间皮瘤、胃癌和胰腺癌中都有明显疗效。其在高危患者预防腹膜转移方面的作用似乎尚不明确。随机对照研究在卵巢癌中取得了阳性结果，但在其他有腹膜播散的疾病中并非如此。一项针对有腹膜转移的胃癌的随机对照研究得出了提示性但非决定性的结果。已有报道称，对于有腹膜转移的胃癌和胰腺癌，在反复腹腔内给予紫杉醇治疗后进行了转化手术。腹腔内紫杉醇的药理学强烈表明，腹腔内给药应有助于预防或治疗腹膜转移。肿瘤学家可遵循的实现这些潜在益处的方案目前尚未可得。
