PERITONEAL METS: new, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)
IMPORTANT UPDATE: International Registry of Patients Treated With Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) (PIPACRegis) https://clinicaltrials.gov/ct2/show/NCT03210298 See recent post below, down in the thread.
Principal characteristics:
-A new system of drug delivery, to the interior of the peritoneum.
-Palliative for peritoneal carcinomatosis. The aim is better quality of life; still, there are cases of complete response.
-Available at several European locations, mainly, in Germany.
-It's minimally invasive (laparoscopic access to the peritoneum).
-Chemotherapy gets delivered (as aerosol, under pressure) directly over the cancer.
-Low systemic toxicity, therefore, low side effects and the possibility of continuing I.V., systemic chemo or immuno.
-Possible even in cases that are not CRS/HIPEC candidates.
-In clinical trials (see below) BUT already has been used in many patients (due the German laws (German Medical Act Law) and because it's not a new agent but a new technique of drug delivery).
-Developed by Dr Prof Marc Reymond, MD MBA (at the present, Professor of Surgery, Director, PIPAC Program, Dept. of Surgery and Transplantation, University Hospital,Tübingen, Germany).
-Several tertiary care centres (University hospitals) in Germany and in Switzerland use the procedure; Ghent, in Belgium; Singapore in Asia. I think that also a location in Denmark. And in my country, ARGENTINA, at our main cancer research institute : ) Only place in the Americas.
-}ongoing clinical trial in Italy (https://clinicaltrials.gov/ct2/show/NCT02604784)
- -Denamark: https://clinicaltrials.gov/ct2/show/NCT03280511
https://clinicaltrials.gov/ct2/show/NCT03287375
-It is performed at many locations, outside the trials.
-It is possible to contact the group that manage the technology, to find out about locations: http://www.capnomed.de
Description of the procedure/ state of art:
"The method of Pressurised IntraPeritoneal Aerosol Chemotherapy (PIPAC) allows the dispersion of chemotherapeutic agents within the peritoneal cavity by means of minimal-invasive techniques. Even if PIPAC represents a new treatment modality, it is not an experimental treatment. Over a thousand applications have been performed in few specialised centres in Europe rendering promising results.
PIPAC is a surgical procedure that can only be applied by laparoscopy. The fumigation as a gas allows a homogeneous dispersion of chemotherapy within the peritoneal cavity; the administration under pressure (standard in laparoscopic surgery) increases the local tissue penetration of the molecules allowing high intratumoral concentrations. The procedure is performed under general anesthesia. Two trocars are inserted via two small incisions (5-12 mm) into the peritoneal cavity; the subsequent air insufflation grants the necessary workspace (schema). First, small tissue samples of the tumour knots are retrieved (biopsy). Then, the chemotherapy is dispersed as pressurised aerosol inside the peritoneal cavity, acting during 30 minutes. At the end of the procedure, the pressure is released and the gas aspirated, and the skin incisions are closed. The whole procedure lasts about 90 minutes. The length of hospital stay is usually 3 days. Today, 3 applications are recommended within 3 months (delay between the applications: 6 weeks)."
-Main criteria for PIPAC are:
> previous guideline-recommended chemotherapy
> disease limited to the peritoneal cavity
> no parenchymatous metastases (liver, lung, bone, ...)
> no small bowel obstruction, ability to eat, no gastric tubing, no parenteral feeding
> ECOG 1 or 2 (Karnofsky 60% or more)
There is a selection of the main literature about PIPAC in the Google Drive: https://drive.google.com/drive/folders/ ... sp=sharing )
Videos in German, about the procedure:
1. Dr Reymond explaining the technique (at that moment, he was at Ruhr-University Bochum; now he's bases in Tübingen, Germany). https://www.youtube.com/watch?v=daxKArtpjtQ
2. Other doctors at Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV) , Switzerland. https://www.youtube.com/watch?v=R02zC2HMYfw
3. Dr Reymond on German news, showing the device, explaining the technique https://www.youtube.com/watch?v=N_lqdRDf4RQ