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HIPEC Methodology and Regimens: The Need for an Expert Consensus

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Hyperthermic intraperitoneal chemotherapy (HIPEC) is performed with a wide variation in methodology, drugs, and other elements vital to the procedure. Adoption of a limited number of regimens could increase the collective experience of peritoneal oncologists, make comparison between studies more meaningful, and lead to a greater acceptance of results from randomized trials. This study aimed to determine the possibility of standardizing HIPEC methodology and regimens and to identify the best method of performing such a standardization.

Methods

A critical review of preclinical and clinical studies evaluating the pharmacokinetic aspects of different HIPEC drugs and drug regimens, the impact of hyperthermia, and the efficacy of various HIPEC regimens as well as studies comparing different regimens was performed.

Results

The preclinical and clinical data were limited, and studies comparing different regimens were scarce. Many of the regimens were neither supported by preclinical rationale or data nor validated by a dose-escalating formal phase 1 trial. All the regimens were based on pharmacokinetic data and did not take chemosensitivity of peritoneal metastases into account. Personalized medicine approaches such as patient-derived tumor organoids could offer a solution to this problem, although clinical validation is likely to be challenging.

Conclusions

Apart from randomized trials, more translational research and phases 1 and 2 studies are needed. While waiting for better preclinical and clinical evidence, the best way to minimize heterogeneity is by an expert consensus that aims to identify and define a limited number of regimens for each indication and primary site. The choice of regimen then can be tailored to the patient profile and its expected toxicity and the methodology according regional factors.

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Authors and Affiliations

  1. Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India

    Aditi Bhatt MS, MCh

  2. Department of Surgical Oncology, Catharina Hospital, Eidhoven, The Netherlands

    Ignace de Hingh MD, PhD

  3. Department of Surgical Oncology, Zeikenhuis Oost-Limberg, Genk, Belgium

    Kurt Van Der Speeten MD, PhD

  4. Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland

    Martin Hubner MD, PhD

  5. Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Marcello Deraco MD, PhD & Shigeki Kusamura MD, PhD

  6. Department of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France

    Naoual Bakrin MD, PhD & Olivier Glehen MD, PhD

  7. Department of Clinical Research, Hospices Civils de Lyon, Centre Hospitalier Lyon-sud, Lyon, France

    Laurent Villeneuve MBE, PhD

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Bhatt, A., de Hingh, I., Van Der Speeten, K. et al. HIPEC Methodology and Regimens: The Need for an Expert Consensus. Ann Surg Oncol 28, 9098–9113 (2021). https://doi.org/10.1245/s10434-021-10193-w

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