It's time to warm up to hyperthermic intraperitoneal chemotherapy for patients with ovarian cancer

Abstract

The peritoneal spread of ovarian cancer makes it a potential target for hyperthermic intraperitoneal chemotherapy (HIPEC). Intraperitoneal delivery exposes the tumor to concentrations of cytotoxic drugs much greater than with intravenous delivery, and in vitro studies have also shown that combining hyperthermia and platinum leads to an additive cytotoxic effect. Pharmacokinetic analyses have confirmed very high concentrations of cytotoxic drugs in the peritoneal cavity, with minimal systemic exposure and toxicity. The majority of historical data evaluating HIPEC in ovarian cancer are based on retrospective research, which included heterogeneous groups of patients and drugs used for HIPEC. Recent publications on the findings of prospective studies, including the first randomized trial in which the only difference in intervention was the addition of HIPEC with cisplatin to interval debulking surgery in stage III patients, have shown a benefit in favor of HIPEC. Yet, a recent prospective study from Korea did not find a benefit. Opponents of HIPEC have cited higher rates of complications with this approach, yet most of the serious adverse events observed are likely related to the surgery itself, and are comparable to the rates reported in studies evaluating cytoreductive surgery without HIPEC. Findings from a recent randomized controlled trial showed no delays in initiation or completion of postoperative chemotherapy in patients treated with HIPEC. A growing body of evidence is indicating that it might be time to seriously consider HIPEC as a complementary treatment at the time of cytoreductive surgery for patients with advanced-stage ovarian cancer in the setting of an experienced center. Yet, more research is needed to identify the population of patients who gain the most benefit from this therapy.

<p>Feasibility and safety of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy in patients with advanced stage ovarian cancer: a single-center experience</p>

“…NLHIPEC could combine the pharmacokinetic advantages of HIPEC with the advantages of minimally invasive surgery. Hyperthermia has a direct antitumor effect, increases the penetration of chemotherapy at the peritoneal surface and augments the cytotoxic effects of platinum-based compounds.12 Intraperitoneal chemotherapy has also been proven to improve the survival outcomes of ovarian cancer patients 13,14. Adding hyperthermia to intraperitoneal cisplatin results in synergistic effects, which could further enhance the effect of intraperitoneal chemotherapy 15,16.…”

Upfront debulking surgery versus interval debulking surgery for advanced tubo‐ovarian high‐grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC

“…Equally important, detailed information on the clinical history of the disease, the timing, site, treatment of recurrence, and its results could help in understanding treatment outcome in individual patients. After the study by Van Driel et al was published, despite criticisms, hyperthermic intraperitoneal chemotherapy (HIPEC) intended to complete cytoreductive surgical efforts began to gather interest also in the gynecological oncology community . Only one study published to date has investigated outcomes in a series that compares patients who underwent UDS versus NACT‐IDS treated with cytoreduction according to peritonectomy procedures both combined with HIPEC .…”

Enhancing Delivery of Small‐Molecule‐ and Cell‐Based Therapies for Ovarian Cancer Using Advanced Delivery Strategies

“…Many of the available studies included heterogenous patient populations with conflicting results. [ 103–106 ] There are many variables with HIPEC, drug used, dose, contact time, temperature, and the effect of these needs to be fully established. [ 104 ] Furthermore, HIPEC requires a longer time in the operating room, both for the surgical staff and the patient and the costs and risks of prolonged anesthesia need to be considered.…”

“…[ 104 ] Furthermore, HIPEC requires a longer time in the operating room, both for the surgical staff and the patient and the costs and risks of prolonged anesthesia need to be considered. [ 104 ]…”