PIPAC – Pressurized Intraperitoneal Aerosolized Chemotherapy

Overview

The PIPAC is a novel method for administering chemotherapy within the abdominal cavity. This method allows for the direct treatment of cancers within the peritoneum, an area where systemic chemotherapy has little effect due to the low number of blood vessels in this region, which are unable to effectively transport conventional chemotherapy.

Currently, it is used for palliation and downstaging in patients who are ineligible for cytoreductive surgery (CRS) or hyperthermic intraperitoneal chemotherapy (HIPEC).

The first human application occurred in Germany in 2011, and the technique is still considered experimental today. Nevertheless, the studies conducted and the clinical results obtained indicate that this technique has the potential to become a highly effective treatment, as it has been shown to improve the quality of life by reducing the advanced disease symptoms.

Diseases treated with PIPAC

The following cancers that have spread to the peritoneal cavity may benefit from PIPAC:

Ovarian cancer
Uterine cancer
Gastric cancer
Peritoneal cancer
Colorectal cancer
Appendiceal cancer

PIPAC vs HIPEC

PIPAC and HIPEC are both intraperitoneal chemotherapy therapies; however, their procedures differ, and depending on the patient and cancer, one may be more appropriate than the other.

HIPEC administers heated chemotherapy into the abdomen of cancer patients with PC, but requires debulking surgery to remove all visible tumors prior to chemotherapy administration.

Both options permit unique translational research and tumor analysis, which may lead to a deeper understanding of cancer, the launch of new research initiatives, and the development of additional therapeutics. It is essential to understand that HIPEC and PIPAC are not alternatives to systemic chemotherapy, but rather complement it. Systemic chemotherapy is typically administered both before and after HIPEC for gastric, colon, and ovarian carcinomas. In peritoneal pseudomyxoma and mesothelioma, systemic chemotherapy is typically not required in addition to HIPEC. Between one and the other, the patient is given four to six weeks to recover from surgery. In contrast, PIPAC and systemic chemotherapy are typically administered two weeks after the intervention, intercalated.

Preparation for PIPAC

The PIPAC procedure does not require any special preparation. Your medical team may schedule PIPAC every six to eight weeks. If you are also receiving a stem cell transplant, you may need to wait between 7 and 10 days for the medication to leave your system. The doctor may prescribe anticoagulant medication the night before PIPAC to prevent blood clots. Just prior to the procedure, sleep-inducing medication will be administered.

Procedure

During treatment, the surgical team performs a minimally invasive laparoscopic procedure that permits 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, including typically difficult-to-reach tumor cells. The administration of chemotherapy takes approximately 30 minutes, and the entire procedure lasts between 60 and 90 minutes. Up to six cycles of PIPAC are delivered every six weeks.

The hospitalization of patients treated with the PIPAC technique generally lasts 24 to 48 hours. After being diagnosed with PIPAC, you may be hospitalized overnight. Most patients respond well to the treatment. Few adverse effects occur. You may experience some discomfort, mild abdominal pain, or mild nausea. PIPAC can enhance your standard of living. The procedure could alleviate symptoms such as abdominal pain and swelling. If you do experience pain after PIPAC, it should be brief.

Benefits of PIPAC

One of the significant advantages of this new technique is that it is administered uniformly and locally to the affected area, thereby minimizing the side effects of systemic treatments. The clinical results indicate that, with the control of adverse effects, it can become a highly effective therapy.

Other benefits of PIPAC:

Improved tolerability due to the brief duration of minimally invasive procedures. The patients are observed overnight and discharged within two days.
Aerosolization and pressurization drive the chemotherapy deeper into the tissue and into every corner of the abdominal cavity, resulting in a more uniform distribution.
To achieve efficacy, lower doses of chemotherapy are required, resulting in a lower toxicity profile compared to conventional chemotherapy administration.
The procedure is repeatable. It can be administered frequently and offers numerous opportunities for tumor staging and response evaluation.
It allows to treat patients with a high disease burden, such as colorectal and gastric cancer, when surgical debulking is not feasible.

For patients with peritoneal cancer who are unable to undergo surgical debulking or HIPEC, the PIPAC is an excellent alternative.