Importance of standardizing the dose in hyperthermic intraperitoneal chemotherapy (HIPEC): a pharmacodynamic point of view

Mas-Fuster, Maria Isabel; Ramon-Lopez, Amelia; Nalda-Molina, Ricardo

doi:10.1007/s00280-013-2204-z

Cited by 14 publications

(13 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…T A B L E 5 Deterioration of HRQOL at discharge, 4 wk after discharge and 3 mo postoperative relative to day before CRS and HIPEC Following the theoretical concept of concentration-based IP chemotherapy; one would expect fixed peritoneal levels of the chemotherapeutic agent and highly variable plasmatic levels of the drug. 12 Therefore, the parameter most influencing the PA in the HIPEC-CONC group is AUC plasma. This explains our findings that AUC plasma and AUC UF were negatively correlated with PA in both treatment groups and that a positive correlation for AUC PF and PA was only found in the HIPEC-BSA group.…”

Section: Discussionmentioning

confidence: 99%

“…Following the theoretical concept of concentration‐based IP chemotherapy; one would expect fixed peritoneal levels of the chemotherapeutic agent and highly variable plasmatic levels of the drug . Therefore, the parameter most influencing the PA in the HIPEC‐CONC group is AUC plasma.…”

Section: Discussionmentioning

confidence: 99%

“…From the Dedrick formula we know that peritoneal concentration and not peritoneal dose is the driving diffusion force . In that context, concentration‐based chemotherapy offers a more predictable exposure of the tumor nodules to the IP chemotherapy and thus efficacy . Unfortunately, the price to be paid for a better prediction of the efficacy of the IP chemotherapy is a higher unpredictability of the systemic toxicity.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Body surface area‐based vs concentration‐based perioperative intraperitoneal chemotherapy after optimal cytoreductive surgery in colorectal peritoneal surface malignancy treatment: COBOX trial

Lemoine

Thijssen

Carleer

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and Objectives Cytoreductive surgery (CRS) and hyperthermic intraperitoneal perioperative chemotherapy (HIPEC) are the standard of care for patients diagnosed with colorectal peritoneal surface malignancy (PSM). Despite a clearly defined standardization of CRS, a large variety of HIPEC modalities are still used in clinical practice. Methods Body surface area (BSA)‐ and concentration‐based HIPEC protocols were clinically and pharmacologically evaluated in a randomized phase III clinical pilot trial. Oxaliplatin dose was 460 mg/m 2 (BSA‐based) in 2 L/m 2 carrier solution (concentration‐based). Platinum quantification was performed using a validated inductively coupled plasma mass spectrometry method. Three‐month morbidity, mortality, and health‐related quality of life (HRQOL) were assessed. Results Thirty‐one patients were randomized to either BSA‐ or concentration‐based HIPEC. Toxicity and efficacy were higher (P < 0.001) in patients receiving concentration‐based HIPEC. There was no difference in pharmacologic advantage between the two groups. A higher drug concentration in the tumor nodule at the end of HIPEC was found in the HIPEC‐concentration group. There was no difference in major morbidity and mortality between the treatment groups. HRQOL was decreased 3 months postoperatively in the HIPEC‐concentration group. Conclusion Concentration‐based chemotherapy delivers the drug in the most standardized way to the tumor nodule, resulting in increasing drug concentrations in the tumor nodule without increasing major morbidity.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Body surface area‐based vs concentration‐based perioperative intraperitoneal chemotherapy after optimal cytoreductive surgery in colorectal peritoneal surface malignancy treatment: COBOX trial

Lemoine

Thijssen

Carleer

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…Therefore, it can be assumed that by the diffusion model, less concentrated chemotherapy would penetrate to a lesser extent into the cancer nodules and normal tissues. On the other hand, concentration-based chemotherapy offers a more predictable exposure of the tumor nodules to the IP chemotherapy and thus efficacy [47]. Unfortunately, the prize to be paid for a better prediction of the efficacy of the IP chemotherapy is a high unpredictability of the plasmatic cancer chemotherapy levels and thus toxicity.…”

Section: Body Surface Area-based or Concentration-based Ip Chemotherapymentioning

confidence: 99%

“…gov/ct2/show/NCT03028155). Table 2 summarizes the clinical trials comparing oxaliplatin-based and mitomycin c-based HIPEC [45][46][47]. Except for the study by Leung et al all these studies show similar clinical outcome which seems to suggest non-inferiority of either drug [47].…”

Section: Body Surface Area-based or Concentration-based Ip Chemotherapymentioning

confidence: 99%

Overview of the optimal perioperative intraperitoneal chemotherapy regimens used in current clinical practice

Speeten

Lemoine

Sugarbaker

2017

Pleura and Peritoneum

View full text Add to dashboard Cite

Peritoneal surface malignancy (PSM) is a common manifestation of digestive and gynecologic malignancies alike. At present, patients with isolated PSM are treated with a combination therapy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The combination of CRS and intraperitoneal (IP) chemotherapy should now be considered standard of care for PSM from appendiceal epithelial cancers, colorectal cancer and peritoneal mesothelioma. Although there is a near universal standardization regarding the CRS, we are still lacking a much-needed standardization among the various IP chemotherapy treatment modalities used today in clinical practice. Pharmacologic evidence should be generated to answer important questions raised by the myriad of variables associated with IP chemotherapy.

show abstract

Effect of intraperitoneal chemotherapy concentration on morbidity and survival

et al. 2020

View full text Add to dashboard Cite

Background Selected patients with colorectal peritoneal metastases are treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The concentration of intraperitoneal chemotherapy reflects the administered dose and perfusate volume. The aim of this study was to calculate intraperitoneal chemotherapy concentration during HIPEC and see whether this was related to clinical outcomes. Methods An observational multicentre study included consecutive patients with colorectal peritoneal metastases who were treated with CRS–HIPEC between 2010 and 2018 at three Dutch centres. Data were retrieved from prospectively developed databases. Chemotherapy dose and total circulating volumes of carrier solution were used to calculate chemotherapy concentrations. Postoperative complications, disease‐free and overall survival were correlated with intraoperative chemotherapy concentrations. Univariable and multivariable logistic regression, Cox regression and survival analyses were performed. Results Of 320 patients, 220 received intraperitoneal mitomycin C (MMC) and 100 received oxaliplatin. Median perfusate volume for HIPEC was 5·0 (range 0·7–10·0) litres. Median intraperitoneal chemotherapy concentration was 13·3 (range 7·0–76·0) mg/l for MMC and 156·0 (91·9–377·6) mg/l in patients treated with oxaliplatin. Grade III or higher complications occurred in 75 patients (23·4 per cent). Median overall survival was 36·9 (i.q.r. 19·5–62·9) months. Intraperitoneal chemotherapy concentrations were not associated with postoperative complications or survival. Conclusion CRS–HIPEC was performed with a wide variation in intraperitoneal chemotherapy concentrations that were not associated with complications or survival.

show abstract

Importance of standardizing the dose in hyperthermic intraperitoneal chemotherapy (HIPEC): a pharmacodynamic point of view

Cited by 14 publications

References 5 publications

Body surface area‐based vs concentration‐based perioperative intraperitoneal chemotherapy after optimal cytoreductive surgery in colorectal peritoneal surface malignancy treatment: COBOX trial

Body surface area‐based vs concentration‐based perioperative intraperitoneal chemotherapy after optimal cytoreductive surgery in colorectal peritoneal surface malignancy treatment: COBOX trial

Overview of the optimal perioperative intraperitoneal chemotherapy regimens used in current clinical practice

Effect of intraperitoneal chemotherapy concentration on morbidity and survival

Contact Info

Product

Resources

About