Intraperitoneal Chemotherapy for Peritoneal Metastases: Technical Innovations, Preclinical and Clinical Advances and Future Perspectives

Our plain-English summary of Intraperitoneal Chemotherapy for Peritoneal Metastases: Technical Innovations, Preclinical and Clinical Advances and Future Perspectives, by N. Christou, C. Auger, S. Battu, et al (Biology, 2021).

The study

• Authors: N. Christou, C. Auger, S. Battu, F. Lalloué, M.O. Jauberteau-Marchan, C. Hervieu, M. Verdier, M. Mathonnet
• Journal: Biology
• Published: 2021;10(3)
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

(1) Background: Tumors of the peritoneal serosa are called peritoneal carcinosis. Their origin may be primary by primitive involvement of the peritoneum (peritoneal pseudomyxoma, peritoneal mesothelioma, etc.). This damage to the peritoneum can also be a consequence of the dissipation of cancers-in particular, digestive (stomach, pancreas, colorectal, appendix) and gynecological (ovaries) ones in the form of metastases. The aim of the treatment is a maximal reduction of the macroscopic disease called "cytoreduction" in combination with hyperthermic intra-abdominal chemotherapy to treat residual microscopic lesions. (2) Methods: In this narrative review, we fundamentally synthetize the evolution of this process over time and its impact on clinical applications. (3) Results: Over the last past decade, different evolutions concerning both delivery modes and conditions concerning hyperthermic intra-abdominal chemotherapy have been realized. (4) Conclusion: The final objective of these evolutions is the improvement of the global and recurrence-free survival of primary and secondary malignant peritoneal pathologies. However, more large randomized controlled trials are needed to demonstrate the efficacy of such treatments with the help of molecular biology and genetics.

In plain English

This article was a narrative review of how chemotherapy delivered directly into the abdominal cavity (intraperitoneal chemotherapy) has developed for cancers of the peritoneum, the lining of the abdomen. It covered primary peritoneal cancers, including malignant peritoneal mesothelioma and pseudomyxoma peritonei. It also covered cancers spreading to the peritoneum from the colon and rectum, stomach, ovary, pancreas and appendix. The review described delivery methods, including heated chemotherapy during surgery (HIPEC), pressurized aerosol chemotherapy (PIPAC) and early postoperative chemotherapy, plus the drugs used and laboratory research. It listed peritoneal mesothelioma among the recognized uses of HIPEC combined with surgery to remove visible tumor. It also noted that no randomized controlled trials were found for peritoneal mesothelioma or pseudomyxoma peritonei. It cited studies reporting a survival benefit with surgery plus HIPEC for peritoneal mesothelioma patients whose disease was removed. Separately, it noted a randomized trial launched to test PIPAC in unresectable malignant peritoneal mesothelioma. The authors concluded that this treatment will probably become commonly used for precise indications, and that larger randomized trials are still needed. The review did not discuss asbestos.

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: Published literature on intraperitoneal chemotherapy for primary peritoneal cancers (including malignant peritoneal mesothelioma and peritoneal pseudomyxoma) and for peritoneal carcinomatosis spreading from colorectal, gastric, pancreatic, ovarian and appendiceal cancers. No search dates or number of studies reviewed are given.
• Exposure: Not an asbestos exposure study. The review concerns treatment: intraperitoneal chemotherapy delivered as HIPEC, PIPAC, EPIC and other modes, using drugs such as cisplatin, carboplatin, oxaliplatin, doxorubicin, mitoxantrone, 5-fluorouracil, docetaxel, paclitaxel and mitomycin C.
• Main results:
  • The review listed peritoneal mesothelioma, together with stage III epithelial ovarian cancer and pseudomyxoma peritonei, as recognized indications for HIPEC combined with cytoreductive surgery.
  • For peritoneal mesothelioma and pseudomyxoma peritonei, which the review called rare, no randomized controlled trials were found in the literature.
  • The review stated that peritoneal mesothelioma makes up around a third of all mesotheliomas. It cited studies reporting a positive impact of cytoreductive surgery with HIPEC, leading to a survival benefit, for patients whose disease was resected.
  • The review cited a prospective study from a single Italian center of 32 patients with pseudomyxoma peritonei of appendiceal origin (2008 to 2016). In that study, cytoreductive surgery with closed-abdomen HIPEC was reported to give a five-year overall survival rate of 58%.
  • The review reported the currently recommended PIPAC regimen for etiologies including mesothelioma as 1.5 mg/m2 of doxorubicin plus 7.5 mg/m2 of cisplatin.
  • The review noted that a randomized controlled trial (NCT03574493) had been launched to test whether PIPAC improves overall survival in patients with unresectable malignant peritoneal mesothelioma.
• The authors' conclusion: The authors concluded that, with advances in delivery modes and future predictive biomarkers, intraperitoneal chemotherapy will probably become a commonly used treatment for precise indications. They also concluded that more large randomized controlled trials are needed to demonstrate its efficacy.
• Limitations the authors state:
  • The authors noted evidence that cytoreductive surgery with HIPEC carries significant morbidity and mortality.
  • The authors noted that other studies in the literature have questioned the legitimacy of the procedure.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Peritoneum, Peritoneal Mesothelioma, Cytoreductive Surgery, Recurrence-Free Survival.

Related studies

• 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)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands — T.R. van Oudheusden, V.E. Lemmens, et al. (2015)
• Phase II Trial of Adjuvant Dendritic Cell Vaccine in Combination with Celecoxib, Interferon-α, and Rintatolimod in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases — R. Ramanathan, H. Choudry, et al. (2021)
• Repeated Cytoreduction Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Selected Patients Affected by Peritoneal Metastases: Italian PSM Oncoteam Evidence — E.M. Pasqual, A.P. Londero, et al. (2023)
• Advances in systemic therapy for malignant mesothelioma: future perspectives — N. Sobhani, S.P. Corona, et al. (2017)

Browse more research in Biology, or return to medical research.