Dr. Lee on Differences Between HIPEC and PIPAC in mCRC

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.