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

Abstract

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.

HIPEC Methodology and Regimens: The Need for an Expert Consensus

“…However, all three modes of IPC have shown benefits in the neoadjuvant/palliative setting also in the presence of gross disease, used either alone or in combination with SC. [44][45][46][47] The IPC may be acting on the translymphatic spread or in combination with SC, which reduces the size of tumor nodules, facilitating destruction by IPC. This may be an important mechanism that can explain the differential response in different tumors.…”

Current Trends in Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Disease from Appendiceal and Colorectal Malignancies

“…The ICARuS study is an important ongoing phase 2 RCT that will directly compare CRS/HIPEC vs. CRS/EPIC and will hopefully answer questions regarding which method offers superior efficacy (NCT01815359). Additionally, for difficult-to-treat cancers with poor responses to current systemic therapy and CRS/HIPEC regimens, long-term EPIC regimens have demonstrated longer-term benefits with additional studies underway (NCT05056389) [ 155 , 156 ].…”

DIAGNOSTICS, TREATMENT AND PROGNOSIS IN PATIENTS WITH COLORECTAL CANCER AND PERITONEAL CARCINOMATOSIS (review)

“…Отметим, что ни одного проспективного рандомизированного исследования III фазы с PIPAC не проведено, что ограничивает применение данного метода пока только рамками клинических исследований. Отдельно выделяется нормотермическая внутрибрюшинная химиотерапия на протяжении длительного времени (NIPEC-LT), которая изучалась при раке яичников и раке желудка [135] и, по сути, представляет собой сочетание внутривенного и внутрибрюшного введения химиопрепарата в течение нескольких курсов. Однако, по результатам III фаз исследований, никакого статистически значимого улучшения общей выживаемости от добавления внутрибрюшинного компонента к системной химиотерапии получено не было ни при раке желудка [136], ни при раке яичников [137].…”