HIPEC: Standard of Care for Ovarian Cancer?

Carrie Langstraat, MD, Mayo Clinic, Rochester, Minnesota, explores hyperthermic intraperitoneal chemotherapy (HIPEC) as the standard of care for ovarian cancer, a topic she debated at the 2022 Great Debates and Updates in Women’s Oncology virtual meeting.

In this debate, Dr Langstraat noted several studies which are investigating the efficacy and safety of HIPEC as standard of care for patients with ovarian cancer. Dr Langstraat argued while there is cause for further investigation, at this time there is no evidence that HIPEC should become the standard-of-care treatment.

Transcript:

Hi, I'm Carrie Langstraat. I'm a gynecologic oncologist at the Mayo Clinic in Rochester, Minnesota. And I'm going to talk to you a little bit today about the use of HIPEC in the treatment of ovarian cancer. HIPEC is not a new technology. It is a treatment using heated chemotherapy at the time of surgery, that has been used in other peritoneal malignancies such as appendiceal cancer and metastatic colorectal cancer. In those diseases, it has shown some benefits to progression-free as well as overall survival. In ovarian cancer, there are quite a few phase 2 studies that have shown that HIPEC is safe for delivery at the time of an ovarian cancer debulking surgery. There is also one good randomized controlled trial done in the Netherlands that has shown benefit of HIPEC in patients that were treated with neoadjuvant chemotherapy.

Then there were 2 additional studies, one that was just recently published this year that looked at all patients that had ovarian cancer, those that had a primary debulking or those that had neoadjuvant chemotherapy and then underwent an interval debulking surgery with HIPEC. In that study by Lim et al, they did not show a benefit to HIPEC. The difference in that study with the van Driel trial, which did show a benefit to HIPEC, was just the patient selection.

HIPEC may have some benefits in ovarian cancer. Where our data is, currently, is in the use of HIPEC at the time of interval debulking surgery for those patients that underwent neoadjuvant chemotherapy. In those patients, they had 3 to 4 cycles of neoadjuvant chemotherapy. They were then randomized to HIPEC or no HIPEC at the time of interval debulking. In that study, they saw an improvement in time to recurrence as well as improvement in overall survival. There are advocates that look to give HIPEC at any point in treatment of ovarian cancer. Although it seems it might be safe with minimal risk, there really is no evidence at this time to say that that is the right thing to do for our patients.

In summary, where our data currently lies for ovarian cancer is that HIPEC is a safe option for patients undergoing debulking surgery. The drug of choice currently is cisplatin. The dose has not yet been determined and some studies use cisplatin 75 mg/m2 for 90 minutes or 60 minutes. The van Driel trial used cisplatin 100 mg/m2 over 90 minutes. That seems to be the drug and dose of choice at this time. And really the data is showing that the most benefit right now is in those patients that had 3 cycles of neoadjuvant chemotherapy, had an interval debulking surgery with HIPEC, and then received additional chemotherapy.

Sources:

Langstraat, C. Debate: HIPEC: Standard of Care? – NO. Presented at: Great Debates & Updates in Women’s Oncology. Sep 21-23, 2022. Virtual.

Lim MC, Chang SJ, Park B, et al. Survival after hyperthermic intraperitoneal chemotherapy and primary or interval cytoreductive surgery in ovarian cancer: A randomized clinical trial. JAMA Surg. 2022;157(5):374-383. doi: 10.1001/jamasurg.2022.01

van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med. 2018;378:230-240. doi:10.1056/NEJMoa1708618