To define both the toxicity and efficacy of intraperitoneal
mitoxantrone in the treatment of refractory ovarian
carcinoma, 31 patients were entered onto a phase II trial of this agent delivered in a 2 L treatment volume on a monthly basis. Due to excessive local
pain at the initial dose level (30 mg/m2), the amount of
drug delivered with each treatment course was reduced to 20 mg/m2. Despite this reduction, 74% of patients required
narcotic analgesia during treatment. In addition, there were four episodes of bowel obstruction (one requiring surgical intervention) during
therapy, and two patients developed bowel obstruction and intraabdominal
abscesses following the completion of treatment. Six of 18 evaluable patients (33%) whose largest
tumor diameter was less than or equal to 1 cm
at protocol initiation experienced surgically documented responses, compared with one of 11 patients (9%) whose largest
tumor was greater than 1 cm in diameter. If the two patients exhibiting what we called a mixed response to treatment are included, seven of 21 patients previously treated with intraperitoneal
cisplatin responded to this treatment program, including four patients who had failed to respond to intraperitoneal
cisplatin. No responding patient has demonstrated clinical evidence of relapse with a median follow-up of 7 months (range, 3+ to 13+ months) from response
laparotomy. Intraperitoneal
mitoxantrone is an active treatment program in patients with small-volume refractory ovarian
carcinoma, but local toxicity can be severe. Due to the toxicity encountered with this specific program, its use cannot be recommended for standard clinical practice. However, in view of the activity observed in refractory ovarian
carcinoma, including responses in patients who had previously failed intraperitoneal
cisplatin, it is important to continue to explore alternative therapeutic regimens using intraperitoneal
mitoxantrone to reduce local toxicity while maintaining or improving efficacy.