Pressurised intraperitoneal aerosol chemotherapy: rationale, evidence, and potential indications

Our plain-English summary of Pressurised intraperitoneal aerosol chemotherapy: rationale, evidence, and potential indications, by M. Alyami, M. Hübner, F. Grass, et al (The Lancet. Oncology, 2019).

The study

• Authors: M. Alyami, M. Hübner, F. Grass, N. Bakrin, L. Villeneuve, N. Laplace, G. Passot, O. Glehen, V. Kepenekian
• Journal: The Lancet. Oncology
• Published: 2019;20(7):e368-e377
• Type of article: Review
• Cited by: 270 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pressurised intraperitoneal aerosol chemotherapy (PIPAC) was introduced as a new treatment for patients with peritoneal metastases in November, 2011. Reports of its feasibility, tolerance, and efficacy have encouraged centres worldwide to adopt PIPAC as a novel drug delivery technique. In this Review, we detail the technique and rationale of PIPAC and critically assess its evidence and potential indications. A systematic search was done to identify all relevant literature on PIPAC published between Jan 1, 2011, and Jan 31, 2019. A total of 106 articles or reports on PIPAC were identified, and 45 clinical studies on 1810 PIPAC procedures in 838 patients were included for analysis. Repeated PIPAC delivery was feasible in 64% of patients with few intraoperative and postoperative surgical complications (3% for each in prospective studies). Adverse events (Common Terminology Criteria for Adverse Events greater than grade 2) occurred after 12-15% of procedures, and commonly included bowel obstruction, bleeding, and abdominal pain. Repeated PIPAC did not have a negative effect on quality of life. Using PIPAC, an objective clinical response of 62-88% was reported for patients with ovarian cancer (median survival of 11-14 months), 50-91% for gastric cancer (median survival of 8-15 months), 71-86% for colorectal cancer (median survival of 16 months), and 67-75% (median survival of 27 months) for peritoneal mesothelioma. From our findings, PIPAC has been shown to be feasible and safe. Data on objective response and quality of life were encouraging. Therefore, PIPAC can be considered as a treatment option for refractory, isolated peritoneal metastasis of various origins. However, its use in further indications needs to be validated by prospective studies.

Copyright © 2019 Elsevier Ltd. All rights reserved.

In plain English

This article was a systematic review, not a new study of patients. The authors searched the medical literature from January 2011 to January 2019 for reports on pressurised intraperitoneal aerosol chemotherapy (PIPAC), a treatment that sprays chemotherapy drugs as an aerosol into the abdomen through small surgical openings. It is used for cancer that has spread within the abdominal cavity. They analysed 45 clinical studies covering 1810 procedures in 838 patients, 58 of whom had peritoneal mesothelioma. The article did not discuss asbestos. Across all studies, adverse events above grade 2 followed 12 to 15% of procedures. No deaths were seen in prospective trials, and mortality in retrospective studies was 2.7%. Quality of life was reported as stable or improved. The review reported clinical response in 67 to 75% of patients with peritoneal mesothelioma, with median survival of 27 months. The authors concluded that PIPAC can be considered safe and promising for advanced isolated refractory peritoneal disease. They noted that no studies had compared PIPAC with other treatments.

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: systematic review of published studies (no meta-analysis; descriptive pooling)
• Who was studied: 45 clinical studies published January 1, 2011 to January 31, 2019, totalling 1810 PIPAC procedures in 838 patients; 58 (7%) had peritoneal mesothelioma, the rest mainly ovarian, gastric and colorectal cancer
• Exposure: the treatment PIPAC (aerosolised intraperitoneal chemotherapy with cisplatin plus doxorubicin, or oxaliplatin alone); asbestos exposure was not studied
• Main results:
  • 58 of the 838 patients had peritoneal mesothelioma
  • Across all study types, adverse events above CTCAE grade 2 occurred after 12 to 15% of procedures
  • No deaths in prospective trials; mortality in retrospective studies was 2.7%
  • Patients with peritoneal mesothelioma: clinical response 67 to 75%, median survival 27 months
  • Patients with ovarian cancer: objective clinical response 62 to 88%
  • Patients with gastric cancer: clinical response 50 to 91%, median survival 8.4 to 15.4 months
  • Quality of life was stable or improved in the studies that measured it
  • Studies of occupational exposure of staff to the chemotherapy aerosol found very low risk with adequate safety measures
• The authors' conclusion: The authors concluded that PIPAC can be considered a safe and promising treatment alternative for patients with advanced isolated refractory peritoneal disease
• Limitations the authors state:
  • Meta-analysis was not feasible because the data were heterogeneous
  • No comparative data; selection bias possible
  • No studies compared PIPAC with other treatments
  • Patient overlap between studies from the same groups
  • Long-term data not yet available

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Quality of Life, Ovarian Cancer, Median Survival, Stomach Cancer, Colorectal Cancer, Peritoneal Mesothelioma, Metastasis.

Related studies

• Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis — M. Alyami, J. Gagniere, et al. (2017)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)
• Oxaliplatin use in pressurized intraperitoneal aerosol chemotherapy (PIPAC) is safe and effective: A multicenter study — O. Sgarbura, M. Hübner, et al. (2019)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) — K. Odendahl, W. Solass, et al. (2015)
• Intraperitoneal chemotherapy: rationale, applications, and limitations — O.M. Al-Quteimat, M.A. Al-Badaineh (2014)

Browse more research in The Lancet. Oncology, or return to medical research.