Harnessing PIPAC to Improve Outcomes in Peritoneal Carcinomatosis

In a conversation with CancerNetwork®, Benjamin Golas, MD, spoke about the current treatment landscape for patients with peritoneal carcinomatosis, discussing how the use of pressurized intraperitoneal aerosolized chemotherapy (PIPAC) may offer improvements in clinical outcomes.

Golas is the chief of Surgical Oncology of the Central Region for Hackensack Meridian Health.

According to Golas, standard therapeutic approaches include combining cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), which may cause collateral damage to healthy tissue while eliciting toxicities such as nausea, vomiting, and bone marrow suppression. Additionally, certain surgical procedures may last up to 14 hours and confer an extensive morbidity profile, thereby increasing complication rates.

Golas described how PIPAC, a minimally invasive laparoscopic technique, may help avoid pain and other adverse effects associated with surgery while facilitating more direct delivery of chemotherapy in the peritoneal cavity. He noted that treatment with PIPAC typically takes 45 minutes to an hour, allowing some patients to return home on the same day of the procedure.

Although clinicians are still learning the correct indications for PIPAC, Golas stated that any patient with peritoneal carcinomatosis should be a candidate to receive treatment with this strategy. Furthermore, he described how the next steps for improving outcomes in this population include finding new ways to incorporate PIPAC into more extensive treatment plans for patients.

“PIPAC is a new treatment and a new potential option that doesn't replace systemic chemotherapy, but I do think it can work in conjunction with systemic chemotherapy. We can offer this bimodal approach where we're directly treating the peritoneal disease and offering [intravenous] chemotherapy,” Golas stated. “We clearly have a long way to go in terms of clinical trials and learning what the best ways are to use this. But there are patients out there who will benefit from that, so I think referral to a center that focuses and has expertise in PIPAC for patients with peritoneal carcinomatosis is critical.”