Peritoneal malignancies may arise from various organs, including but not limited to the colon, appendix, stomach, ovary, or adrenal gland. However, peritoneal tumor deposits tend to be relatively resistant to traditional intravenous systemic chemotherapy regimens that are otherwise effective for disease involving other sites, such as the liver or lungs. Administration of intraperitoneal chemotherapy allows much higher chemotherapeutic drug levels to be achieved in the peritoneal cavity, with far less systemic absorption and toxicity than if given intravenously at the same dose. However, intraperitoneal chemotherapy is only effective after cytoreductive surgery, where all disease >2.5 mm has been completely removed or ablated. Unfortunately, many patients with peritoneal carcinomatosis have high burdens of disease, which may preclude optimal cytoreduction or lead to such debilitation that extensive surgical resection would not be tolerated by the patient.

Dr. Blakely’s research primarily focuses on developing treatment strategies that bring the potential benefits of pre-operative therapy to patients with peritoneal surface malignancies. Neoadjuvant intraperitoneal chemotherapy administration may reduce peritoneal surface disease burden, which in turn facilitates or even obviates subsequent cytoreductive surgery. In addition, for patients experiencing symptomatic malignant ascites, intraperitoneal chemotherapy alone can effectively palliate unresectable patients.