An NCI-designated Comprehensive Cancer Center
By City of Hope | July 5, 2018
Thanh H Dellinger Thanh Dellinger, M.D.
There’s a part of the body most people don’t hear much about.
It’s the membrane that surrounds the machinery of digestion and reproduction in the abdomen. It’s called the peritoneum. And for some patients with ovarian, gastric, colorectal and other cancers in the abdomen, it can complicate their treatment.
The peritoneum (pronounced “pear-uh-tuh-NEE-um”) can become the avenue cancer uses to jump from one structure in the belly to another. When tumors develop in the peritoneum itself, they tend to be particularly difficult to treat.
Gynecologic oncologist Thanh Dellinger, M.D., is up to the challenge.
“We have to do more than focus on treating one site. Cancer can travel anywhere in that cavity,” said Dellinger, assistant professor of gynecologic surgery at City of Hope. “Peritoneal malignancies need to be treated very differently.”
She works with a peritoneal surface malignancy team that crosses the borders between disciplines. The closely integrated group encompasses surgeons, gynecologists, medical oncologists, radiologists, anesthesiologists, intensivists and basic scientists, to name a few. Together, they push the envelope in treatment and research — including assuming leadership in a sophisticated therapy that can be found few places outside of City of Hope.

Turning Up the Heat on Cancer

Because the peritoneum is veined scantly compared to other organs in the body, traditional chemotherapy administered through the bloodstream is less effective against tumors that arise or spread there.
An alternative approach — delivering chemotherapy directly to the peritoneum — was identified as a standard of care for ovarian cancer by the National Cancer Institute in 2006. Embracing this strategy, City of Hope is one of the highest volume centers for intraperitoneal chemotherapy in the National Comprehensive Cancer Network.
City of Hope has become a leader in a complex hybrid procedure that builds on intraperitoneal chemotherapy. Combining aggressive surgery with hyperthermal intraperitoneal chemotherapy, or HIPEC, it involves circulating heated medication in a patient’s abdomen right on the operating table.
Currently offered through clinical trials, HIPEC with aggressive surgery provides an extra option to patients with cancer that has not spread beyond the abdominal cavity. City of Hope performs more HIPEC procedures than any other center in Los Angeles County — about one a week — and currently is the only place in the county offering HIPEC for ovarian cancer.
In the procedure, surgeons perform an extensive operation removing every trace of cancer visible within the abdomen, often in a tag team approach.
Immediately after, the medical team delivers chemotherapy warmed up to 107 degrees Fahrenheit. On the one hand, the heat aids in the absorption of the medication. On the other, cancer cells are particularly vulnerable to high heat. The aim is to eliminate every microscopic trace of cancer in the abdomen.
The entire process can take six hours and more. According to Dellinger, the procedure — difficult for the medical team and often taxing on patients — is worth it to offer ovarian cancer patients their best chance to beat the disease. She points to research results from Europe published in the New England Journal of Medicine showing a nearly one-year survival benefit for HIPEC compared to chemotherapy alone.
This is no longer an experimental therapy,” Dellinger said. “This is something we know has clear benefits.”
Dellinger credits the peritoneal surface malignancy team’s critical mass of experience and expertise across fields, along with the ability to bring those disparate fields together.
“Not everybody can be an expert in everything. The kind of smooth, collaborative mentality we have at City of Hope is something very special,” she said.

Not Done Yet

Far from content with what’s available to patients today, Dellinger and her teammates also cultivate future therapies meant to enable patients with peritoneal cancer to live longer, healthier lives.
One clinical trial under development in collaboration with Mayo Clinic will test a further evolution of HIPEC: pressurized intraperitoneal aerosolized chemotherapy, or PIPAC.
The plan is to pair PIPAC with a gentler diagnostic surgery that uses laparoscopic equipment. The spray is expected to reach every corner of the abdominal cavity, for more cancer-killing coverage, while requiring a smaller dose of chemotherapy to reduce side effects for patients.
Human trials in Europe have examined PIPAC, with promising results. The City of Hope-Mayo Clinic study will be the first of its kind in the United States.
“We believe we can optimize HIPEC; make it even better,” Dellinger said.
She also furthers a variety of advanced approaches to beating ovarian cancer with teammates in City of Hope laboratories.
She is collaborating with Karen Aboody, M.D., professor of developmental and stem cell biology and neurosurgery, and Jacob Berlin, Ph.D., associate professor of molecular medicine, to develop a targeted therapy. It uses neural stem cells — which are naturally attracted to tumors — to deliver cancer-killing nanoparticles within the peritoneal cavity. Other partnerships foster potential treatments employing custom-engineered viruses, antibodies and immune cells.
“That interdisciplinary approach is what attracted me to City of Hope,” Dellinger said. “We consider each other partners in trying to improve patient care.”
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