Intraperitoneal Infusion of Recombinant Tumor Necrosis Factor for Palliative Therapy of Terminally ill Patients with Refractory Malignant Ascites.

Abstract

Background: Refractory malignant ascites in extensive carcinomatous peritonitis presents a major problem in oncology, especially in patients with extensive tumor dissemination and final-stage cancer. Patients near death require treatment that is effective while providing major palliative benefits, and that is something neither paracentesis nor chemotherapy can offer. Patients and Methods: Recombinant human tumor necrosis factor (rhuTNF, Knoll AG, Ludwigshafen) was given to 13 female patients with refractory malignant ascites and imminently terminal cancer. The substance was administered 33 times in total by the intraperitoneal (i.p.) route. Depending on response and general condition the patients were treated 2 or 3 times at weekly intervals at a dose of 0.08 mg/m2 of body-surface area.Results: Regeneration of ascites stopped in all cases. As expected, a significant life-prolonging effect was not achieved. Side effects were kept at a minimum by taking careful account of the condition of each individual patient and administering co-medication accordingly. Conclusion: Intraperitoneal infusion of rhuTNF can help to control ascites in carcinomatous peritonitis patients while causing almost no side effects, thus providing comfort for incurably ill patients.