# The New Era of Intraperitoneal Carboplatin in Ovarian Cancer: From Biological Rationale to Clinical Implementation

## TL;DR

This review discusses how intraperitoneal carboplatin can be a more effective and safer treatment for ovarian cancer, especially when combined with modern therapies.

## Contribution

The paper highlights the potential of IP carboplatin across various treatment settings, including suboptimal cytoreduction and PARP inhibitor use.

## Key findings

- IP carboplatin shows promise in all residual tumor strata, including suboptimal cytoreduction.
- It provides high local concentrations while maintaining systemic levels similar to intravenous delivery.
- IP carboplatin may enhance initial responses in tumors with homologous recombination deficiency.

## Abstract

This review explores the expanding clinical role of intraperitoneal (IP) carboplatin in ovarian cancer, transcending the traditional “optimal debulking only” paradigm. Based on the iPocc trial, IP carboplatin shows promise across all residual tumor strata, including suboptimal cytoreduction and the neoadjuvant chemotherapy followed by interval debulking surgery setting. Mechanistically, “bidirectional” exposure—attaining high local concentrations while maintaining systemic levels comparable to intravenous delivery—supports efficacy even in the presence of larger residual disease. Additionally, we discuss the integration of IP therapy into the current PARP inhibitor era. Intensified IP platinum exposure may deepen the initial clinical response, particularly in tumors with homologous recombination deficiency, thereby optimizing the therapeutic landscape for subsequent maintenance. While further data on catheter complications and PARP inhibitor interactions are warranted, IP carboplatin may represent a viable intensification strategy for selected patients in contemporary ovarian cancer management.

Epithelial ovarian cancer is predominantly characterized by peritoneal dissemination, providing a strong biological rationale for intraperitoneal (IP) chemotherapy. Although IP cisplatin-based regimens have demonstrated substantial survival benefits in pivotal randomized trials, toxicity and catheter-related complications limit their widespread adoption. IP carboplatin has emerged as a pragmatic alternative with improved tolerability while preserving its pharmacokinetic advantages. This review summarizes the biological and pharmacological rationale for IP carboplatin and critically examines the clinical evidence, with a particular emphasis on the Intraperitoneal Carboplatin for Ovarian Cancer (iPocc) trial and its divergence from Gynecologic Oncology Group (GOG)-252. We further discuss the potential applicability of IP carboplatin beyond the traditional setting of minimal residual disease, including patients undergoing neoadjuvant chemotherapy and interval debulking surgery, as well as its possible use in the contemporary era of maintenance therapy. Collectively, the accumulated evidence supports renewed consideration of IP carboplatin as a versatile component in modern ovarian cancer management.