Localized chemotherapy approaches and advanced drug delivery strategies: a step forward in the treatment of peritoneal carcinomatosis from ovarian cancer

Abstract

Peritoneal carcinomatosis (PC) is a common outcome of epithelial ovarian carcinoma and is the leading cause of death for these patients. Tumor location, extent, peculiarities of the microenvironment, and the development of drug resistance are the main challenges that need to be addressed to improve therapeutic outcome. The development of new procedures such as HIPEC (Hyperthermic Intraperitoneal Chemotherapy) and PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) have enabled locoregional delivery of chemotherapeutics, while the increasingly efficient design and development of advanced drug delivery micro and nanosystems are helping to promote tumor targeting and penetration and to reduce the side effects associated with systemic chemotherapy administration. The possibility of combining drug-loaded carriers with delivery via HIPEC and PIPAC represents a powerful tool to improve treatment efficacy, and this possibility has recently begun to be explored. This review will discuss the latest advances in the treatment of PC derived from ovarian cancer, with a focus on the potential of PIPAC and nanoparticles in terms of their application to develop new therapeutic strategies and future prospects.

Keywords: PIPAC technique; cancer treatment; nanomedicine; ovarian cancer; peritoneal carcinomatosis (PC).

Figure 1

Overview of the PIPAC procedure and the application of nanomedicine for the treatment of peritoneal carcinomatosis. Bottom left: schematic representation of intraperitoneal aerosolization of nanoparticles by PIPAC; top left: schematic representation of tumor nodules with tumor infiltrating immune cell populations and delivered nanoparticles. (A) Nanoparticles can be modified by adding surface moieties of different origins to increase their targeting and penetration capabilities into the tumor. (B) Delivery systems are designed to increase the concentration and residence time of the drug at the tumor site compared with free drug. (C) Delivery systems designed to carry genetic material are used to induce silencing of specific genes on tumor or immune cells to promote direct or immune-mediated destruction of tumor cells.