HIPEC in Ovarian Cancer: Is It for Everyone?

Hyperthermic intraperitoneal chemotherapy (HIPEC) could improve outcomes for women with ovarian cancer, especially when given at the time of interval debulking. However, results are mixed when it comes to the procedure’s true benefit.

“Heated intraperitoneal chemotherapy provides us with another option for patients who receive neoadjuvant chemotherapy and undergo interval debulking surgery,” said Ernest S. Han, MD, PhD, FACOG, in an interview with OncLive, a sister publication of Oncology Nursing News.

“It seems to be safe, based on the randomized trial data. However, we do need more clinical trials to further support this approach,” Han, assistant clinical professor at the Division of Gynecologic Oncology, Department of Surgery, City of Hope, said.

Mixed Results

A randomized phase III trial conducted in the Netherlands showed that women with newly diagnosed stage III epithelial ovarian cancer who received HIPEC during surgery were 34% less likely to experience recurrence or death compared to those who just had surgery alone. Additionally, women in the HIPEC arm (122 patients) had longer average relapse-free survival compared to the surgery group (123 patients), at 14.2 months and 10.7 months, respectively. Overall survival (OS) was also improved with HIPEC, with median OS being 45.7 months in the HIPEC arm versus 33.9 months in the surgery arm.

However, in a similar trial, HIPEC did not demonstrate the same benefit.

“[W]e didn’t see that same level of excitement in the last clinical trial that looked at (intraperitoneal) chemotherapy,” Han said. “We found that the (ntraperitoneal)-based arms were essentially the same as IV chemotherapy. There are different reasons why that might be. Having said that, 3 of the 4 large trials have shown the strength of chemotherapy administered directly to the abdomen.”

HIPEC in Practice

When it comes to analyzing the available data and making a decision as to whether or not HIPEC should be used in practice or not, Han said, “it has to be looked at with caution,” especially because of the adverse events (AEs) associated with the procedure.

“It’s also important that you have the institutional support and the hospital support to perform these types of treatments, as they can be toxic,” Han said.

“In our own institutions, we’ve seen patients who have had some renal toxicity and other toxicities from the operation. We are still trying to help optimize the conditions that patients can get back to health as soon as possible.”

Han described giving heated chemotherapy as a “double whammy” to patients after they undergo a major debulking surgery. Since the process could be so intense, he mentioned that age is a major factor when deciding if a patient should or should not get HIPEC.

Treatment Requires Teamwork

Members of multiple disciplines must work together to ensure the safety and recovery of patients treated with HIPEC. For the actual procedure, surgical and gynecologic oncologists will often work together.

Then comes the long recovery process, which often includes significant bowel dysfunction. In this stage, the nursing staff is crucial.

“It takes a multidisciplinary team approach, and it takes institutional and nursing support to get patients through the recovery process,” Han said. “We need major supportive care from nursing, occupational and physical therapy and the nutrition staff.”

Reference

van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med. 2018;378:230-240. doi: 10.1056/NEJMoa1708618.

A version of this article originally appeared on OncLive as, “Search Continues for Optimal HIPEC Use in Ovarian Cancer.”