Dr Pedersen on the Evolving Use of Cytoreductive Surgery for Peritoneal Carcinomatosis

Katrina S. Pedersen, MD, MS, associate professor, Division of Oncology, Washington University School of Medicine, discusses the evolving use of cytoreductive surgery for patients with peritoneal carcinomatosis in gastrointestinal (GI) malignancies.

There are ongoing efforts taking place aiming to standardize treatment with cytoreductive surgery across GI malignancies, particularly in the context of peritoneal carcinomatosis, Pedersen begins. Continued refinement of these approaches and an acceleration in research maylead to more conclusive trials elucidating the benefits of cytoreduction and other intraperitoneal treatments, Pedersen explains. These approaches include hyperthermic intraperitoneal chemotherapy (HIPEC) or early post-operative intraperitoneal chemotherapy, which involves the delivery of chemotherapy or other medical treatments directly into the abdominal cavity, she details.

Despite the longstanding existence of cytoreduction with or without HIPEC, the utility of this approach remains limited and difficult to access, Pedersen notes. This is because the surgeries require highly specialized surgeons to perform, have a prolonged duration, and are only performed at a limited number of centers, Pedersen explains. However, recent trials, such as the large, phase 3 PRODIGE 7 trial (NCT00769405) in France have shown that patients undergoing cytoreduction experienced significantly greater survival rates compared with those receiving systemic therapy alone, Pedersen reports, adding that this underscores the potential of cytoreductive surgery in patients with GI malignancies, she adds.

As research accelerates in this field, there is optimism that large data-driven advancements will provide a clearer understanding of the patient populations that would benefit most from cytoreductive treatments, Pedersen says. Moving forward, continued support and investment in research are crucial to better understand the optimal candidates for cytoreductive treatment, Pedersen says. By leveraging the insights gained from ongoing studies and refining patient selection criteria, the goal is to maximize the benefits of cytoreductive surgery and intraperitoneal therapies for patients with peritoneal carcinomatosis, she concludes.