Cancer chemotherapy: alternative routes of drug administration. A review.

This review covers recent developments in regional cancer chemotherapy, including the pharmacological background, technical progress, and clinical experience. Intrathecal chemotherapy is an approach that has acquired an established place, although its ultimate potentials are not known yet. The therapeutic value of hepatic intraarterial drug infusion is still unclear, although this route has been used for more than 20 years. Furthermore, the evaluation of alternative routes via the pleural and peritoneal cavities and other arteries is still in an experimental phase. Interest in these treatment modalities has been stimulated by a number of recent developments in separate fields. Major technical advances have been made, including surgically placed and totally implantable elastic catheters and subcutaneous portals and pumps. In addition, a pharmacokinetic model describing the fate of drugs administered via an artery or cavity has been developed. These developments have made it possible not only to design randomized studies and treat a larger number of patients in a relatively short time with reduced morbidity, but also to improve greatly the selection of drugs, target organs, and administration schedules. Ongoing clinical studies can be expected to lead to improved treatment results as well as provide data on dose-response relationships and drug schedule dependency for specific tumor types.