Drugs, doses, and durations of intraperitoneal chemotherapy: standardising HIPEC and EPIC for colorectal, appendiceal, gastric, ovarian peritoneal surface malignancies and peritoneal mesothelioma

Our plain-English summary of Drugs, doses, and durations of intraperitoneal chemotherapy: standardising HIPEC and EPIC for colorectal, appendiceal, gastric, ovarian peritoneal surface malignancies and peritoneal mesothelioma, by L. Lemoine, P. Sugarbaker, K. Van der Speeten (International Journal of Hyperthermia, 2017).

The study

• Authors: L. Lemoine, P. Sugarbaker, K. Van der Speeten
• Journal: International Journal of Hyperthermia
• Published: 2017;33(5):582-592
• Cited by: 54 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal surface malignancy (PSM) is a common manifestation of digestive and gynaecologic malignancies alike. At present, patients with isolated PSM are treated with a combination therapy of cytoreductive surgery (CRS) and hyperthermic peroperative intraperitoneal chemotherapy (HIPEC). The combination of CRS and intraperitoneal (IP) chemotherapy should now be considered standard of care for PSM from appendiceal epithelial cancers, colorectal cancer and peritoneal mesothelioma. Although there is a near universal standardisation regarding the CRS, we are still lacking a much-needed standardisation amongst the various IP chemotherapy treatment modalities used today in clinical practice. Pharmacologic evidence should be generated to answer important questions raised by the myriad of variables associated with IP chemotherapy.

In plain English

This article was a review, not a new study. The authors reviewed published data on the drugs, doses and treatment times used when chemotherapy is put directly into the abdominal cavity (intraperitoneal chemotherapy) for cancer that has spread over the abdominal lining, including treatment given before, during and after cytoreductive surgery. It covered cancers of colorectal, appendiceal, gastric and ovarian origin and peritoneal mesothelioma. It did not study asbestos exposure. The authors noted that the surgery is standardised but that no standardised intraperitoneal chemotherapy methods exist. They described heated chemotherapy given during surgery (HIPEC), which uses drugs that do not depend on the cell cycle and can be given once. They also described early postoperative chemotherapy (EPIC), which uses drugs such as 5-fluorouracil and the taxanes in repeated cycles of about 23 hours. For peritoneal mesothelioma, the article listed mitomycin C, given as HIPEC and EPIC, and a paclitaxel EPIC regimen. A newer aerosol method (PIPAC) had no phase III trial data. The authors concluded that pharmacologic evidence is still needed to standardise intraperitoneal chemotherapy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review
• Who was studied: No patients were studied directly. The review covers published work on intraperitoneal chemotherapy for peritoneal surface malignancy from colorectal, appendiceal, gastric and ovarian cancer, and for peritoneal mesothelioma.
• Exposure: Not an asbestos exposure study. The review covers intraperitoneal chemotherapy drugs (including cisplatin, carboplatin, oxaliplatin, melphalan, mitomycin C, doxorubicin, docetaxel, paclitaxel, 5-fluorouracil, gemcitabine and pemetrexed), their doses and durations, and delivery methods given before, during or after cytoreductive surgery (NIPS, HIPEC, bidirectional chemotherapy, EPIC), as well as PIPAC.
• Main results:
  • The authors reported that, although cytoreductive surgery is standardised, no standardised intraperitoneal chemotherapy treatment methods exist.
  • HIPEC was described as heated chemotherapy given during the operation.
  • The review also discussed neoadjuvant chemotherapy given into the abdomen and into a vein before cytoreductive surgery (NIPS).
  • The drugs used for HIPEC were described as non-cell-cycle specific, which suits a single instillation.
  • For EPIC, the authors described cell-cycle specific drugs such as 5-fluorouracil and the taxanes, given in multiple cycles with a dwell time of around 23 hours each.
  • Mitomycin C was described as used for diffuse malignant peritoneal mesothelioma, both as HIPEC and as EPIC.
  • An EPIC regimen with paclitaxel on postoperative days 1 to 5 was listed for peritoneal mesothelioma and ovarian cancer.
  • The authors stated that PIPAC (pressurized intraperitoneal aerosol chemotherapy) had no phase III trial data and was still experimental.
• The authors' conclusion: The authors concluded that cytoreductive surgery combined with intraperitoneal chemotherapy should now be considered standard of care for peritoneal surface malignancy from appendiceal epithelial cancers, colorectal cancer and peritoneal mesothelioma. They also concluded that intraperitoneal chemotherapy still needs standardisation, that pharmacologic evidence is needed, and that PIPAC should be tested in phase III trials.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Chemotherapy, HIPEC, Peritoneal Mesothelioma, Cytoreductive Surgery, Colorectal Cancer.

Related studies

• The Role of Hyperthermic Intraperitoneal Chemotherapy for Non-colorectal Peritoneal Surface Malignancies — M.C. Morris, J.M. Cloyd, et al. (2021)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma — T.P. Batista, B.J.Q. Sarmento, et al. (2017)
• Dose-Dependent Effect of Red Blood Cells Transfusion on Perioperative and Long-Term Outcomes in Peritoneal Surface Malignancies Treated with Cytoreduction and HIPEC — E. Nizri, S. Kusamura, et al. (2018)
• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)
• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)

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