HIPEC Methodology and Regimens: The Need for an Expert Consensus

Background Hyperthermic intraperitoneal chemotherapy (HIPEC) is performed with a wide variation in methodology, drugs, and other elements vital to the procedure. Adoption of a limited number of regimens could increase the collective experience of peritoneal oncologists, make comparison between studi...

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Bibliographic Details
Published in:Annals of surgical oncology 2021-12, Vol.28 (13), p.9098-9113
Main Authors: Bhatt, Aditi, de Hingh, Ignace, Van Der Speeten, Kurt, Hubner, Martin, Deraco, Marcello, Bakrin, Naoual, Villeneuve, Laurent, Kusamura, Shigeki, Glehen, Olivier
Format: Article
Language:English
Subjects:
Chemotherapy
Clinical trials
Hyperthermia
Medicine
Medicine & Public Health
Metastases
Oncology
Organoids
Patients
Peritoneal Surface Malignancy
Peritoneum
Pharmacokinetics
Precision medicine
Standardization
Surgery
Surgical Oncology
Toxicity
Tumors
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Summary:Background Hyperthermic intraperitoneal chemotherapy (HIPEC) is performed with a wide variation in methodology, drugs, and other elements vital to the procedure. Adoption of a limited number of regimens could increase the collective experience of peritoneal oncologists, make comparison between studies more meaningful, and lead to a greater acceptance of results from randomized trials. This study aimed to determine the possibility of standardizing HIPEC methodology and regimens and to identify the best method of performing such a standardization. Methods A critical review of preclinical and clinical studies evaluating the pharmacokinetic aspects of different HIPEC drugs and drug regimens, the impact of hyperthermia, and the efficacy of various HIPEC regimens as well as studies comparing different regimens was performed. Results The preclinical and clinical data were limited, and studies comparing different regimens were scarce. Many of the regimens were neither supported by preclinical rationale or data nor validated by a dose-escalating formal phase 1 trial. All the regimens were based on pharmacokinetic data and did not take chemosensitivity of peritoneal metastases into account. Personalized medicine approaches such as patient-derived tumor organoids could offer a solution to this problem, although clinical validation is likely to be challenging. Conclusions Apart from randomized trials, more translational research and phases 1 and 2 studies are needed. While waiting for better preclinical and clinical evidence, the best way to minimize heterogeneity is by an expert consensus that aims to identify and define a limited number of regimens for each indication and primary site. The choice of regimen then can be tailored to the patient profile and its expected toxicity and the methodology according regional factors.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-021-10193-w