Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

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Maia
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Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Maia » Mon Dec 12, 2016 2:53 pm

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
Last edited by Maia on Fri Oct 13, 2017 7:47 am, edited 4 times in total.

daisy9051
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Joined: Sat Jan 18, 2014 3:24 pm

Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby daisy9051 » Mon Dec 12, 2016 4:40 pm

Amazing! thanks for posting
40 yo mom of 4 girls
4/13: 14 cm L ovarian muc adeno, pthlgy consistent w colon primary
Neg scopes/ CT
6/13: surgery, NED, 0/22 LN, no primary found
8/13: neg MRI, scopes, XELOX 3x
10/15: recur periaortic lymph nodes/peritoneum
12/15: HIPEC w/ oxi
1/16: start FOLFOX, bowel obstructions post-op

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Maia
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Joined: Fri Aug 24, 2012 8:00 am

Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Maia » Mon Dec 12, 2016 9:00 pm

You're welcome!
Hope it helps someone, eventually : )

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CRguy
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Joined: Sun Feb 10, 2008 6:00 pm

Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby CRguy » Mon Dec 12, 2016 9:12 pm

Pushing the envelope with higher tech
THIS is what progress looks like !!!!

Thanks Maia
CR
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

plastikos
Posts: 351
Joined: Wed Jan 14, 2015 6:09 am

Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby plastikos » Tue Dec 13, 2016 2:40 am

Looks promising for patiens who qualify for it. Definitely cant hurt.
St. IV Colon CA @ 37, male, Kras wild, MSI-high (2014)
11/2014 Right Hemicolectomy + Liver Resection
12/2014 - 6/2015 FOLFOX + Cetuximab
10/2015 - Recurrence liver
Liver resection 10/2015
FOLFIRI 11/2015 - 5/2016
Recurrence liver, nodes 11/2016
Pembrolizumab started 12/2016 -> pseudoprogression(?) -> biliary obstruction -> biliary stenting
Chemo 4x: most mets inactive and smaller on PET-CT
March 2017 - Back on Pembrolizumab again
Sept 2017 - SIRT - > NED
2019 NED

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Maia
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Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Maia » Fri Oct 13, 2017 7:45 am

IMPORTANT UPDATE. October 2017

Many locations, not USA:
Argentina, Australia, Belgium, Denmark, France, Germany, India, Italy, Poland, Russian Federation, Singapore, Spain, Switzerland

International Registry of Patients Treated With Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) (PIPACRegis)

https://clinicaltrials.gov/ct2/show/NCT03210298

Intervention Details:
Combination Product: PIPAC
A chemotherapeutic solution is aerosolized into the expanded abdominal cavity during laparoscopy, under pressure. This allows a relatively homogeneous repartition of the drug and an effective tissue penetration.
Other Names:
PITAC
Intraperitoneal chemotherapy
Intrathoracic chemotherapy

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Robino1
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Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Robino1 » Fri Oct 13, 2017 9:21 am

Wish it was in the USA. Maybe someday...
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217; 219
FOLFOX started 6/17
CEA 202
8/29/17 CT melting of tumor.
Latest CT scan shows 2 new tumors and return of ascites.
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3; 2/1-84.2; 89.2; 89.8; 88.5; 81.8: 93.5; 107; 119
BRAF V600e

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Maia
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Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Maia » Fri Oct 13, 2017 9:35 am

As it says in the main post, Mayo will be the first place, probably. The idea was they were starting this year, at least with a trial.

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Robino1
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Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Robino1 » Fri Oct 13, 2017 9:53 am

I will try to keep an eye on this one. :)
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217; 219
FOLFOX started 6/17
CEA 202
8/29/17 CT melting of tumor.
Latest CT scan shows 2 new tumors and return of ascites.
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3; 2/1-84.2; 89.2; 89.8; 88.5; 81.8: 93.5; 107; 119
BRAF V600e


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Robino1
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Facebook Username: Robin.lawthers
Location: Florida

Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Robino1 » Sun Nov 05, 2017 6:01 pm

Maia wrote:Robino, hasn't you checked this at University of Miami?
https://clinicaltrials.gov/ct2/show/NCT01815359


Not sure if I will qualify. There was cancer on my liver also. I know the tumor has shrunk but don't know by how much. It was fairly large. And there is all that seeding/caking...

For some reason, HIPEC scares the crap out of me.

I will look into it further after I get back from Thanksgiving vacation. Thank you for the info! :)
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217; 219
FOLFOX started 6/17
CEA 202
8/29/17 CT melting of tumor.
Latest CT scan shows 2 new tumors and return of ascites.
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3; 2/1-84.2; 89.2; 89.8; 88.5; 81.8: 93.5; 107; 119
BRAF V600e

User avatar
Maia
Posts: 2443
Joined: Fri Aug 24, 2012 8:00 am

Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Maia » Sun Nov 05, 2017 7:33 pm

I was thinking more in the EPIC part --and that maybe they would take the risk of CRS, surgery, which is always good.
And what about an immunotherapy trial? --see my signature--

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Robino1
Posts: 463
Joined: Fri Aug 11, 2017 12:09 pm
Facebook Username: Robin.lawthers
Location: Florida

Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Robino1 » Sun Nov 05, 2017 9:32 pm

Maia wrote:I was thinking more in the EPIC part --and that maybe they would take the risk of CRS, surgery, which is always good.
And what about an immunotherapy trial? --see my signature--


One of the reasons I'm going to Philly is for a second opinion. My current oncologist said I wouldn't be eligible for a trial since my cancer is responding so well to chemo. I'm still gathering information. The doctor I'm seeing in Philly does do trials and is very involved in them. I'll be finding out more soon.

I'm not discounting anything at this point. I do appreciate, VERY MUCH, all the info you have given me. I thank you for this! :)
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217; 219
FOLFOX started 6/17
CEA 202
8/29/17 CT melting of tumor.
Latest CT scan shows 2 new tumors and return of ascites.
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3; 2/1-84.2; 89.2; 89.8; 88.5; 81.8: 93.5; 107; 119
BRAF V600e

Beckster
Posts: 438
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Beckster » Mon Nov 06, 2017 6:15 am

Robino1 wrote:
Maia wrote:I was thinking more in the EPIC part --and that maybe they would take the risk of CRS, surgery, which is always good.
And what about an immunotherapy trial? --see my signature--


One of the reasons I'm going to Philly is for a second opinion. My current oncologist said I wouldn't be eligible for a trial since my cancer is responding so well to chemo. I'm still gathering information. The doctor I'm seeing in Philly does do trials and is very involved in them. I'll be finding out more soon.

I'm not discounting anything at this point. I do appreciate, VERY MUCH, all the info you have given me. I thank you for this! :)


Thought I would throw this out, since you are going to Philly....my oncologist is also located there. He is with MD Anderson and specializes in gastro cancers, novel therapies and clinical trails.

Here is his link
http://www.cooperhealth.org/physicians/ ... orrison-md
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic
1/2/17 to 6/9/17- Xeloda
6/17,12/17,6/18,12/18,6/19,12/19,12/20,12/21 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0 12/20 2.7 6/21 2.9,[color=#000000]12/21 2.7[/color]
Clear Colonoscopy 10/17, 11/19,11/21 :D

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Robino1
Posts: 463
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Facebook Username: Robin.lawthers
Location: Florida

Re: Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)

Postby Robino1 » Mon Nov 06, 2017 7:08 am

Beckster wrote:
Robino1 wrote:
Maia wrote:I was thinking more in the EPIC part --and that maybe they would take the risk of CRS, surgery, which is always good.
And what about an immunotherapy trial? --see my signature--


One of the reasons I'm going to Philly is for a second opinion. My current oncologist said I wouldn't be eligible for a trial since my cancer is responding so well to chemo. I'm still gathering information. The doctor I'm seeing in Philly does do trials and is very involved in them. I'll be finding out more soon.

I'm not discounting anything at this point. I do appreciate, VERY MUCH, all the info you have given me. I thank you for this! :)


Thought I would throw this out, since you are going to Philly....my oncologist is also located there. He is with MD Anderson and specializes in gastro cancers, novel therapies and clinical trails.

Here is his link
http://www.cooperhealth.org/physicians/ ... orrison-md


Thanks! Another to put in my arsenal. :)
At 54 2014 1st colonoscopy colon cancer detect
Colon resect margins clear. No chemo Stage II
2017
Distend abd, pain in intestines.
CT scan seeding & Ascites
Lap diag - cancer on the omentum
CEA 217; 219
FOLFOX started 6/17
CEA 202
8/29/17 CT melting of tumor.
Latest CT scan shows 2 new tumors and return of ascites.
CEA: (2017)9/30 -109; 10/12 -99.1; 11/4 -90.7; 11/30 -70.7; 12/14 -83.4; (2018)1/4 -73.3; 2/1-84.2; 89.2; 89.8; 88.5; 81.8: 93.5; 107; 119
BRAF V600e


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