Byrne Lee, MD, chief, Upper GI and Mixed Tumor Surgery Service, associate clinical professor of surgical oncology, Department of Surgery, and surgical oncologist, City of Hope, discusses data regarding the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with metastatic colorectal cancer (mCRC).

At the 2019 Gastrointestinal Cancers Symposium, data from the multicenter phase III COLOPEC trial were presented. Investigators evaluated the use of HIPEC as an adjuvant treatment for patients with high-risk CRC; these were patients with perforated colon cancers or T4 colon cancers, says Lee. The goal was to determine whether or not the use of intraperitoneal chemotherapy and cytoreductive surgery would improve survival in these patients. However, data failed to show that the use of HIPEC provided a benefit to patients.

Currently, HIPEC regimens that are used in the United States differ from those that were evaluated in recent trials. In both the PRODIGE 7 and COLOPEC trials, investigators gave oxaliplatin for an infusion time of 30 minutes. In the United States, however, the majority of practices use mitomycin C over a perfusion time of 90 to 120 minutes. That additional perfusion time may help a subset of patients, says Lee. However, more data will need to be gathered before HIPEC becomes part of routine practice, he concludes.

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Dr. Lee on Data Regarding HIPEC in mCRC

Byrne Lee, MD, chief, Upper GI and Mixed Tumor Surgery Service, associate professor of surgical oncology, City of Hope, discusses the benefit of cytoreductive surgery in the treatment of patients with metastatic colorectal cancer (mCRC).

At the 2018 Gastrointestinal Cancers Symposium, the results of the PRODIGE 7 trial were presented by a large French group. The trial examined the use of cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of patients with peritoneal metastases, says Lee. Patients were randomized to receive either surgery alone or surgery with HIPEC; this utilized a more European regimen comprised of oxaliplatin perfused for 30 minutes at 43° Celsius.

There was no improvement in overall survival or progression-free survival (PFS) when HIPEC was used, states Lee. However, the trial did show that cytoreductive surgery is effective, with a median PFS of approximately 40 months in both arms. Based on these results, physicians believe that with appropriate patient selection, cytoreductive surgery confers benefit for patients with peritoneal metastases.

Dr. Lee on the Benefit of Cytoreductive Surgery in Metastatic Colorectal Cancer

Byrne Lee, MD, chief, Upper GI and Mixed Tumor Surgery Service, associate professor of surgical oncology, City of Hope, discusses the differences between hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the treatment of patients with metastatic colorectal cancer (mCRC).

HIPEC utilizes heated intraperitoneal chemotherapy, which Lee likens to a bath. Physicians use a machine to perfuse the abdomen at a constant rate and temperature. This modality is generally used after cytoreductive surgery because the goal is to reduce the peritoneal metastases to microscopic disease. HIPEC is a standard approach in the United States for patients with mCRC.

PIPAC is a new way of delivering chemotherapy to the abdomen, Lee says. This approach is not used following surgery, Lee notes, so PIPAC can be used in conjunction with systemic chemotherapy. While PIPAC is more widely used in Europe and Asia, he adds. PIPAC allows him to better visualize the treatment because with each session, surgeons can gauge how the cancer is responding to therapy in real-time and it’s relatively safe due to the way that it’s delivered. Although there are benefits to both approaches, Lee thinks that PIPAC will become increasingly more prevalent. Many centers in the United States are interested in looking into this modality, he adds.

Byrne Lee, MD, chief, Upper GI and Mixed Tumor Surgery Service, associate professor of surgical oncology, City of Hope, discusses the differences between HIPEC and PIPAC in the treatment of patients with metastatic colorectal cancer.

Byrne Lee, MD

Articles

Dr. Lee on Data Regarding HIPEC in mCRC

Dr. Lee on the Benefit of Cytoreductive Surgery in Metastatic Colorectal Cancer

Dr. Lee on Differences Between HIPEC and PIPAC in mCRC