Pressurized intraperitoneal aerosol chemotherapy (PIPAC) for rare gynecologic indications: peritoneal metastases from breast and endometrial cancer

Günther A Rezniczek,Urs Giger-Pabst,Clemens B Tempfer,Omar Thaher

doi:10.1186/s12885-020-07627-1

Abstract

BackgroundPeritoneal metastasis (PM) in patients with breast (BC) and endometrial cancer (EC) is rare and treatment options are limited. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) has demonstrated efficacy against PM from various cancers, but its efficacy in BC/EC patients is unknown.MethodsRetrospective cohort study of patients with PM from BC/EC undergoing PIPAC with doxorubicin 1.5 mg/m2 and cisplatin 7.5 mg/m2. Data were collected within an international prospective PIPAC registry. Study outcomes were microscopic tumor regression grade (TRG), survival, adverse events (CTCAE), and quality of life (QoL).Results150 PIPAC procedures in 44 patients (BC/EC = 28/16; mean age 58.8 ± 10.1 and 63.2 ± 10.1 years, respectively) were analyzed. The mean number of PIPACs per patient was 3 (range 0–9) and 3.5 (range 0–10), respectively. Primary/secondary non-access occurred in 4/3 of 150 (5%) procedures. PIPAC induced objective tumor regression as demonstrated by repetitive PM biopsies in 73% (32/44) of patients. Peri- and postoperative CTCAE grade 3 and 4 complications were observed in 12/150 (8%) of procedures. No grade 5 event was observed. After a median follow up of 5.7 (IQR 2.7–13.0) months, overall median survival was 19.6 (95% CI: 7.8–31.5) months (from first PIPAC). QoL indicators (general health, nausea, fatigue, constipation, pain, dyspnea, social, cognitive, emotional, and physical functioning) all improved or were maintained throughout PIPAC treatments.ConclusionsRepetitive intraperitoneal chemotherapy with PIPAC is feasible and safe in patients with PM from BC and EC. PIPAC induces significant histological regression of PM while maintaining QoL.

Highlights

Peritoneal metastasis (PM) in patients with breast (BC) and endometrial cancer (EC) is rare and treatment options are limited
In order to address the feasibility, safety, and efficacy of Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) in patients with breast cancer (BC) and EC, we identified all cases of PM from BC and EC treated with PIPAC in our institution and report the clinical results
In a retrospective cohort study of patients with PM from BC and EC undergoing 150 PIPACs with doxorubicin and cisplatin, we found that this treatment was feasible and induced objective tumor regression grade (TRG) in up to 55% of patients while maintaining quality of life

Summary

Introduction

Peritoneal metastasis (PM) in patients with breast (BC) and endometrial cancer (EC) is rare and treatment options are limited. Peritoneal metastasis (PM) in patients with breast cancer (BC) and endometrial cancer (EC) is a rare and challenging condition. Patients with PM account for less than 3% of recurrent BC and EC cases [1,2,3,4]. In a comprehensive review of the literature, only 21 articles with 505 patients with BC and PM were identified [1]. Based on these data, PM was associated with invasive lobular histology, loss of functional p53, and loss of E-cadherin expression. Ozkan et al found that the 5-year progression-free survival rate of patients with EC and PM was 35% compared to 54% for patients with EC and vaginal vault recurrence [8]

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