Routes of Administration

In addition to the usual intravenous or oral routes, some anticancer agents have been administered by regional intraarterial perfusion to increase drug delivery to the tumor itself and at the same time diminish systemic tox-icity. Thus, patients with metastatic carcinomas of the liver and little or no disease elsewhere (a common occurrence in colorectal cancer) can be treated with a continuous infusion of fluorouracil or floxuridine through a catheter implanted in the hepatic artery.

Intracavitary administration of various agents has been used for patients with malignant pleural or peritoneal effusions. Intraperitoneal instillations of cisplatin, etoposide, bleomycin, 5-fluorouracil, and interferon are well tolerated and are being evaluated in patients with ovarian carcinomas, in whom the tumor is frequently restricted to the peritoneal cavity.

Other routes of administration can be employed in certain situations. Methotrexate and cytarabine are given intrathecally or intraventricularly to prevent relapses in the meninges in acute lymphocytic leukemia and to treat carcinomatous meningitis. Thiotepa and bleomycin have been administered by intravesical instillation to treat early bladder cancers. Fluorouracil can be applied topically for certain skin cancers.

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