Activity of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with cisplatin and doxorubicin in women with recurrent, platinum-resistant ovarian cancer: Preliminary clinical experience

Abstract

ObjectiveTo assess the activity of laparoscopic Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) in women with recurrent, platinum-resistant ovarian cancer. MethodsProspective case series using repeated courses q 28–42days of PIPAC containing cisplatin 7.5mg/m2 and doxorubicin 1.5mg/m2 at 12mmHg and 37°C for 30min. Objective tumor response was defined as tumor regression on histology and peritoneal carcinomatosis index (PCI) improvement on repeated video-laparoscopy. Results34 PIPAC procedures were performed in 18 women, in 8 instances combined with cytoreductive surgery (CRS). Eight women had repeated PIPAC and objective tumor response was observed in 6 (complete remission: 1; partial remission: 2; stable disease: 3). Five adverse events WHO grade≥2 were noted, 3 of them after combined CRS. No perioperative mortality occurred. Median follow-up was 192days (min. 13–max. 639). Cumulative survival after 400days was 62% and mean actuarial survival time was 442days. In a multivariable regression analysis with objective tumor response (yes vs. no) as the dependent variable and PIPAC (1 vs.>1), patient age (<75 vs.≥75years), serum CA-125 (<1000 vs.>1000U/mL), and the presence of ascites (yes vs. no) as independent variables, PIPAC independently predicted objective tumor response. ConclusionPIPAC has activity in women with recurrent, platinum-resistant ovarian cancer and should be investigated in prospective clinical trials.