Consensus statement for treatment protocols in pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Abstract

Objectives Safe implementation and thorough evaluation of new treatments require prospective data monitoring and standardization of treatments. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising alternative for the treatment of patients with peritoneal disease with an increasing number of suggested drug regimens. The aim was to reach expert consensus on current PIPAC treatment protocols and to define the most important research topics. Methods The expert panel included the most active PIPAC centers, organizers of PIPAC courses and principal investigators of prospective studies on PIPAC. A comprehensive literature review served as base for a two-day hybrid consensus meeting which was accompanied by a modified three-round Delphi process. Consensus bar was set at 70% for combined (strong and weak) positive or negative votes according to GRADE. Research questions were prioritized from 0 to 10 (highest importance). Results Twenty-two out of 26 invited experts completed the entire consensus process. Consensus was reached for 10/10 final questions. The combination of doxorubicin (2.1 mg/m2) and cisplatin (10.5 mg/m2) was endorsed by 20/22 experts (90.9%). 16/22 (72.7%) supported oxaliplatin at 120 with potential reduction to 90 mg/m2 (frail patients), and 77.2% suggested PIPAC-Ox in combination with 5-FU. Mitomycin-C and Nab-paclitaxel were favoured as alternative regimens. The most important research questions concerned PIPAC conditions (n=3), standard (n=4) and alternative regimens (n=5) and efficacy of PIPAC treatment (n=2); 8/14 were given a priority of ≥8/10. Conclusions The current consensus should help to limit heterogeneity of treatment protocols but underlines the utmost importance of further research.

Assessment of Treatment Response after Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) for Appendiceal Peritoneal Metastases

“…In the current study we mostly used oxaliplatin as a PIPAC drug. This attitude is still considered up-to-date by the recent consensus on drug regimens [ 39 ]. On the other side, the recent literature questions the role of oxaliplatin as an IP drug after oxaliplatin-based neoadjuvant treatment due to potential resistance.…”

Feasibility and Safety of Taxane-PIPAC in Patients with Peritoneal Malignancies—a Retrospective Bi-institutional Study

“…To administer the drugs, we had to deviate from the current recommendations for performing PIPAC [ 28 ]. The platinum agents and taxanes were not combined in the same syringe.…”

Aplicación de la quimioterapia por aerosolización intraperitoneal presurizada (PIPAC) en la carcinomatosis peritoneal de origen colorrectal

“…La técnica tiene una curva de aprendizaje simple, un entrenamiento establecido con algoritmos creados tanto por un grupo de expertos (PIPAC trained trainers) apoyados por la International Society of Study of the Pleura and Peritoneum (ISSPP -www.isspp.org) sociedad de regulación de la actividad PIPAC, la cual otorga el certificado de entrenamiento, la licencia para poder realizar el procedimiento, proceder con el registro de casos, libre acceso a una base de datos sobre los modelos a utilizar, acceder al dispositivo autorizado para la aerosolización y el acceso a los resultados más recientes concernientes a los avances en la técnica. [20][21][22][23]…”