Intraperitoneal chemotherapy: rationale, applications, and limitations

Our plain-English summary of Intraperitoneal chemotherapy: rationale, applications, and limitations, by O.M. Al-Quteimat, M.A. Al-Badaineh (Journal of Oncology Pharmacy Practice, 2014).

The study

• Authors: O.M. Al-Quteimat, M.A. Al-Badaineh
• Journal: Journal of Oncology Pharmacy Practice
• Published: 2014;20(5):369-80
• Type of article: Review
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Intraperitoneal chemotherapy, involving the administration of certain chemotherapeutic agents directly to the intraperitoneal cavity, was developed as a novel therapeutic strategy early in the 1950s. Intraperitoneal administration of chemotherapy results in higher intraperitoneal concentration of the cytotoxic medications and minimal systemic exposure than observed with intravenous administration, which in turn may increase the efficacy of these agents with substantial reduction in systemic toxicity. Intraperitoneal chemotherapy was used successfully in peritoneal surface malignancies, including malignant peritoneal mesothelioma, pseudomyxoma peritonei, malignant ascites, sarcomatosis, and peritoneal carcinomatosis from gastrointestinal and ovarian cancers. Pharmacists may play a major role in optimizing intraperitoneal chemotherapy through verification of chemotherapy order for proper doses, dilution, preparation, and administration. Moreover, pharmacists are medication experts who can provide other health care professionals with the necessary drug information. Despite the local application of chemotherapy, intraperitoneal chemotherapy is not free of systemic side effects and can be associated with serious complications. The benefits of intraperitoneal chemotherapy should be weighed against its potential harm to maximize efficacy and to minimize morbidity and mortality as much as possible. The aim of this article is to review the current available literature regarding the safety and efficacy of intraperitoneal chemotherapy in cancer treatment.

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In plain English

This article was a review, not an original study. Two authors from the Pharmaceutical Care Department of King Abdullah Medical City in Makkah, Saudi Arabia, reviewed published literature on intraperitoneal chemotherapy, in which cancer drugs are given directly into the abdominal cavity. The article did not discuss asbestos. It covered how the treatment is prepared and given, the pharmacist's role, and its use in several cancers, including diffuse malignant peritoneal mesothelioma. Among the studies it described, a multi-institutional trial by Yan and colleagues treated 405 patients with peritoneal mesothelioma with surgery and intraperitoneal chemotherapy. In that trial, 127 patients (31%) had grade 3 and 4 complications and 9 (2%) died around the time of surgery. Median survival was 53 months, and 3- and 5-year survival rates were 60% and 47%. The authors noted gaps in the evidence and the risks of the treatment. They concluded that intraperitoneal chemotherapy is an effective option for select patients with cancers of the peritoneal surface. They added that its benefits must be weighed carefully against potential harm.

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 of published literature; no search method or inclusion criteria are described
• Who was studied: No patients were studied directly. The review covered published studies of patients with peritoneal surface malignancies: ovarian, colon, gastric and pancreatic cancer, pseudomyxoma peritonei, malignant ascites, peritoneal sarcomatosis, and diffuse malignant peritoneal mesothelioma. The authors were from King Abdullah Medical City, Makkah, Saudi Arabia.
• Exposure: Asbestos exposure was not discussed. The subject was a treatment: intraperitoneal chemotherapy, often heated (HIPEC), given after cytoreductive surgery. For peritoneal mesothelioma the drugs named include doxorubicin, mitomycin, cisplatin, 5-FU and paclitaxel.
• Main results:
  • In a multi-institutional trial by Yan et al., described in the review, 405 patients with peritoneal mesothelioma were treated with cytoreductive surgery and intraperitoneal chemotherapy. Of these, 318 (79%) had epithelial tumors and 48 (12%) had biphasic or sarcomatoid tumors, and 372 (92%) received HIPEC.
  • In that same trial of 405 peritoneal mesothelioma patients, 127 (31%) had grade 3 and 4 complications and 9 (2%) died perioperatively.
  • In that same trial, overall median survival was 53 months (range 1 to 235 months). Survival rates were 60% at 3 years and 47% at 5 years.
  • The review cited a phase II study of 49 patients with malignant peritoneal mesothelioma treated with cytoreductive surgery followed by HIPEC (cisplatin 250 mg/m2) as reporting favorable long-term outcomes.
  • In the GOG-172 trial of stage III ovarian cancer, described in the review, median overall survival was 49.7 months in the intravenous-therapy group and 65.6 months in the intraperitoneal-therapy group.
  • In a randomized trial by Verwaal et al. of 105 patients with peritoneal carcinomatosis from colon cancer, described in the review, overall survival was 12.6 months in the standard arm and 22.3 months in the HIPEC arm. The HIPEC group had a mortality rate of 8%.
  • One study described in the review measured chemotherapy exposure of operating-room staff during the open (coliseum) technique, using urine, air and glove testing. All assessments were negative.
• The authors' conclusion: The authors concluded that intraperitoneal chemotherapy is an effective and clinically applicable option for select patients with peritoneal surface malignancies. They also called for well-designed clinical trials.
• Limitations the authors state:
  • The authors stated that, because of the treatment's morbidity, mortality and risk of procedural complications, its benefits must be weighed carefully against potential harm.
  • The authors noted that no standard approach to managing complications exists, because controlled studies are lacking and techniques, regimens and patient selection vary widely.
  • The authors stated that the evidence for peritoneal sarcomatosis is very limited.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Peritoneal Mesothelioma, Ascites, Ovarian Cancer.

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