Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: A Systematic Review and Meta-analysis

Helm, Joseph H.; Miura, John T.; Glenn, Jason A.; Marcus, Rebecca; Larrieux, Gregory; Jayakrishnan, Thejus; Donahue, Amy; Gamblin, T. Clark; Turaga, Kiran K.; Johnston, Fabian M.

doi:10.1245/s10434-014-3978-x

Cited by 197 publications

(162 citation statements)

References 36 publications

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“…While there is scientific data to advocate the combination of cytoreductive surgery and perioperative intraperitoneal chemotherapy as treatment modality for peritoneal surface malignancies [33][34][35][36][37][38][39], the second component is still far from standardized. Significant variations in intraperitoneal chemotherapy remain and may influence the pharmacokinetics and pharmacodynamics of intraperitoneally delivered drugs, including their dose, the volume and the kind of carrier solution, the technique (open or closed abdomen), the intra-abdominal pressure and temperature, the duration of the intraperitoneal chemotherapy and the extent of (peritoneal) resections (Table 1) [3,18,40].…”

Section: Variables In Pharmacokinetics and Pharmacodynamicsmentioning

confidence: 99%

Pharmacological principles of intraperitoneal and bidirectional chemotherapy

Bree

Michelakis

Stamatiou

et al. 2017

Pleura and Peritoneum

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Intraperitoneal chemotherapy is associated with a significant pharmacokinetic and pharmacodynamic benefit and can, alone or in combination with systemic chemotherapy (bidirectional chemotherapy), be used for treating primary and secondary peritoneal surface malignancies. Due to the peritoneal-plasma barrier, high intraperitoneal drug concentration can be achieved by intraperitoneal chemotherapy, whereas systemic concentration remains low. Bidirectional chemotherapy may provide in addition adequate drug concentrations from the side of the subperitoneal space to the peritoneal tumour nodules. Major pharmacological problems of intraperitoneal chemotherapy are limited tissue penetration and poor homogeneity of drug distribution to the entire seroperitoneal surface. Significant pharmacological determinants of intraperitoneal chemotherapy are choice of drug, drug dosage, solution volume, carrier solution, intra-abdominal pressure, temperature, duration, mode of administration, extent of peritonectomy and interindividual variability. Drugs most commonly applied for intraperitoneal chemotherapy include mitomycin C, cisplatin, carboplatin, oxaliplatin, irinotecan, 5-fluoruracil, gemcitabine, paclitaxel, docetaxel, doxorubicin, premetrexed and melphalan. The drugs and their doses that are used vary widely among centres. While the adequate drug choice for intraperitoneal and bidirectional chemotherapy is essential, randomized clinical trials to determine the most optimal drug or drug combination are lacking, and only eight retrospective comparative clinical studies are available. Further clinical pharmacological studies are required to determine the most effective drug regimen for intraperitoneal and bidirectional chemotherapy in various indications. In the future, reliable drug sensitivity testing and genetic profiling of peritoneal metastases will be needed for enabling patient-specific therapy.

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Section: Variables In Pharmacokinetics and Pharmacodynamicsmentioning

confidence: 99%

Pharmacological principles of intraperitoneal and bidirectional chemotherapy

Bree

Michelakis

Stamatiou

et al. 2017

Pleura and Peritoneum

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“…The early efforts of this multinational coalition to treat peritoneal mesothelioma should be recognized as the initial success of a global attack on this rare malignancy. This literature includes a systematic review and a meta-analysis [30,31]. A multidisciplinary conference in 2006 at the National Institutes of Health sponsored by the National Organization for Rare Diseases concluded that CRS plus perioperative chemotherapy may be considered by the multidisciplinary team as an initial treatment plan for patients with MPM [32].…”

Section: Normothermic Intraperitoneal Chemotherapy Long Term For Malimentioning

confidence: 99%

Normothermic intraperitoneal chemotherapy long term (NIPEC-LT) in the management of peritoneal surface malignancy, an overview

Sugarbaker

2017

Pleura and Peritoneum

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Background: Peritoneal metastases from gynecologic and gastrointestinal cancer is of increasing interest to surgical and medical oncologists because of newly recognized benefits of treatment. In contrast to prior outcomes, prolonged disease-free survival and cure have been reported. Methods: To date, the benefits are to use complete surgical removal of the peritoneal metastases combined with hyperthermic intraperitoneal chemotherapy (HIPEC) delivered in the operating room. To supplement the local-regional control, normothermic intraperitoneal chemotherapy used long term (NIPEC-LT) and delivered by an intraperitoneal port has been explored. Results: In three high grade malignancies with the preponderance of cytoreductive surgery (CRS) and HIPEC treatment failures within the peritoneal space, NIPEC-LT has been favorably reported in the oncology literature. In ovarian cancer and malignant peritoneal mesothelioma the NIPEC-LT is used an adjuvant treatment in an attempt to preserve a surgical complete response of CRS. In gastric cancer, NIPEC-LT is given as a neoadjuvant treatment with responders going on to radical surgical resection. Responses are monitored by laparoscopy. Conclusions: This overview highlights benefits of NIPEC-LT in three diseases where benefits from CRS and HIPEC have been recognized but that local-regional failures persist. Improved results with NIPEC-LT have been reviewed for ovarian cancer, gastric cancer, and peritoneal mesothelioma.

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“…The most recent meta-analysis (twenty publications reporting on 1047 patients), complete crs was achieved in 67% of cases (range: 46%-93%), and pooled estimates of survival yielded 3-and 5-year os rates of 59% and 42% respectively 41 . The drugs used for hipec are doxorubicin, cisplatin, mitomycin C, and docetaxel.…”

Section: Malignant Peritoneal Mesotheliomamentioning

confidence: 99%

“…Prognostic factors for survival after crs and hipec include histologic subtype, proliferative index, lymph node status, disease burden, preoperative serum cancer antigen 125, completeness of crs, and major postoperative morbidity [40][41][42][43][44][46][47][48] . In a single preliminary study 49 , expression of Glut1 was the only factor independently associated with os in multivariate analysis.…”

Section: Malignant Peritoneal Mesotheliomamentioning

confidence: 99%

Treatment of Peritoneal Surface Malignancies with Hyperthermic Intraperitoneal Chemotherapy—Current Perspectives

2016

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Peritoneal carcinomatosis (ptc) represents advanced malignant disease and has generally been associated with a grim prognosis. Peritoneal surface malignancy is often the major source of morbidity and mortality; it is of major concern in cancer management. Although ptc is categorized as metastatic disease, it represents a special disease pattern considered to be a locoregional disease limited to the abdominal cavity. The combination of cytoreductive surgery (crs) and intraoperative hyperthermic intraperitoneal chemotherapy (hipec) has successfully been used as locoregional treatment for selected patients with ptc from gastric, colorectal, and ovarian cancer; with mesothelioma; and with pseudomyxoma peritonei. In the prophylactic setting, hipec can also be used to prevent ptc in high-risk patients, and the first results of the "second-look" approach are promising. Patient selection-in which the risks of perioperative morbidity and mortality, which are analogous to those for any other major gastrointestinal surgery, are assessed-is of utmost importance. Those risks have to be weighed against the anticipated survival benefit, which depends mainly on tumour biology, extent of disease, and probability of achieving complete crs. The present review discusses the principles of crs and hipec, the most significant recent clinical data, and current perspectives concerning the application of this treatment modality in various malignancies. Ongoing trials and future directions are noted. It appears that the combination of crs and hipec is an indispensable tool in the oncologist's armamentarium.

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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: A Systematic Review and Meta-analysis

Abstract: While CRS + HIPEC has led to an improved survival for patients with MPM compared to historic data, heterogeneity of studies precludes generalizable inferences. EPIC chemotherapy and cisplatin chemoperfusion may infer survival benefit.

Cited by 197 publications

References 36 publications

Pharmacological principles of intraperitoneal and bidirectional chemotherapy

Pharmacological principles of intraperitoneal and bidirectional chemotherapy

Normothermic intraperitoneal chemotherapy long term (NIPEC-LT) in the management of peritoneal surface malignancy, an overview

Treatment of Peritoneal Surface Malignancies with Hyperthermic Intraperitoneal Chemotherapy—Current Perspectives

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