Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)

Abstract

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel intraperitoneal drug-delivery technique with the capability of distributing drugs as a pressurized aerosol. Pharmacological advantages of PIPAC are a better homogeneity of drug distribution, a deeper penetration, and a higher drug concentration in the target tissue than intraperitoneal chemotherapy with liquids. PIPAC is a generic technique allowing aerosolization of a large range of therapeutic substances. Current indication is palliative therapy of advanced peritoneal metastasis in various gastrointestinal and gynecological tumors. PIPAC has been shown to be feasible in the vast majority of patients, is safe, has no significant organ toxicity, and is well tolerated. PIPAC does not deteriorate quality of life. Encouraging efficacy data from several phase II clinical studies call for prospective randomized trials. PIPAC might have significant advantages over existing chemotherapy techniques, which are not very effective for treating peritoneal metastasis and are associated with a high risk of adverse events. As an experimental technique, PIPAC has been used in patients who already failed multiple treatment regimens, but it might not be limited to that group of patients in the future.