Currently, there is an unmet need for therapy options for patients whose cancer has spread to the peritoneum.
Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a novel therapeutic method of administering chemotherapy within the abdominal cavity. This approach allows for direct treatment of cancers within the peritoneum, where systemic chemotherapy has little effect due to the low number of blood vessels within this area to transmit traditional chemotherapy effectively.
“Tumors that have spread to the inner [abdominal] lining will frequently cause obstruction of intestines. These patients are not able to get IV chemotherapy because when you have a lot of severe symptoms, the treatments have to be interrupted. We took the lead, knowing that there was a big need for patients to have regional therapy directly into the abdomen. That’s what we’re bringing. It’s not available at other sites right now. This offers a unique opportunity for patients being treated at City of Hope.”
Mustafa Raoof, M.D., M.S., surgical oncologist
City of Hope has a strong history as a high-volume hyperthermic (or heated) intraperitoneal chemotherapy (HIPEC) center and other types of surgical expertise in peritoneal malignancies. PIPAC and HIPEC are both therapies that deliver intraperitoneal chemotherapy; however, they each follow different procedures, and one may be more suited depending on the patient and the cancer.
HIPEC is currently available as a treatment option at City of Hope, while PIPAC is only available through clinical study enrollment. PIPAC may provide another treatment option on top of HIPEC to treat cancers that have spread throughout the peritoneum.
Both options allow for unique translational research and tumor analysis, which could lead to a deeper understanding of cancer, new research ventures and the development of additional therapeutics.
At City of Hope, we currently treat the following using PIPAC:
Physician-scientists at City of Hope have a successful track record of pairing basic and clinical science with leading-edge technology to develop innovative therapies that result in treatment breakthroughs. In addition, institutional resources like the Biological and Cellular GMP Manufacturing Facility enable the onsite development of biologics and other necessary support, including process development and regulatory affairs expertise in cell and gene therapy, recombinant proteins and synthetic molecules.
How Does PIPAC Work?
At the time of treatment, the surgical team performs a minimally invasive laparoscopic procedure that allows for direct access to the abdominal cavity. A high-pressure micro-injection pump converts liquid chemotherapy into an aerosolized spray that can reach every corner of the abdominal cavity, even typically hard-to-reach tumor cells. Chemotherapy delivery takes approximately half an hour, with the entire procedure taking approximately 60 to 90 minutes. PIPAC is delivered every six weeks for up to six cycles.
In addition to direct delivery of chemotherapy into the intraperitoneal cavity, which allows for better absorption of chemotherapy into peritoneal tumors, PIPAC offers a number of advantages:
Better tolerability due to short, minimally invasive procedure time. Patients are monitored overnight and are discharged within a day or two.
Aerosolization and pressurization drives chemotherapy deeper into the tissue and into all corners of the abdominal cavity, which results in better distribution.
Favorable pharmacokinetics are achieved by applying only 10%-20% of the usual systemic dose.
Lower doses of chemotherapy are required to achieve efficacy, which results in a better toxicity profile in comparison to traditional chemotherapy administration.
Treatment is repeatable. It can be delivered frequently and provides multiple opportunities for tumor staging and response assessment.
Treatment is possible in patients with high disease burden, including colorectal and gastric cancer cases, when surgical debulking may not be feasible. This is a great alternative for patients with peritoneal carcinomatosis who are unable to undergo surgical debulking or HIPEC.
NCT04329494: City of Hope is currently enrolling patients in the first-in-the-nation, multisite Phase I clinical trial to study PIPAC in ovarian, uterine, colorectal, appendiceal and gastric cancer patients with peritoneal carcinomatosis. As the study lead, City of Hope is collaborating with the National Cancer Institute, Mayo Clinic and Northwell Health.
Dr. Dellinger and Dr. Raoof have extensive experience conducting research to develop improved therapies for patients with ovarian, uterine, appendiceal and gastrointestinal cancers. The pair are well-versed in delivering chemotherapy through alternative methods, as part of the HIPEC surgical team at City of Hope.
Patient Enrollment Qualifications
18 years of age and older
Histological confirmation of ovarian, uterine, gastric, appendiceal or colorectal cancer with peritoneal metastases
No contraindications for laparoscopy
Progression on at least one evidence-based chemotherapy
When a patient chooses to participate in the PIPAC trial at City of Hope, they extend the benefit to future patients who might be faced with carcinomatosis. Tissue and blood specimens obtained as part of the PIPAC clinical trial will undergo extensive molecular characterization that will help us learn about peritoneal metastases in unprecedented detail. These findings will enable the development of new therapies and also will allow us to personalize therapies to each patient’s tumor type. These studies will not be possible without the extensive translational research infrastructure at City of Hope.
Even if you're not a candidate for PIPAC, other treatments may be available.
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