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01-12-2021 | Cytostatic Therapy | Peritoneal Surface Malignancy

HIPEC Methodology and Regimens: The Need for an Expert Consensus

Authors: Aditi Bhatt, MS, MCh, Ignace de Hingh, MD, PhD, Kurt Van Der Speeten, MD, PhD, Martin Hubner, MD, PhD, Marcello Deraco, MD, PhD, Naoual Bakrin, MD, PhD, Laurent Villeneuve, MBE, PhD, Shigeki Kusamura, MD, PhD, Olivier Glehen, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2021

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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Title: HIPEC Methodology and Regimens: The Need for an Expert Consensus
Authors: Aditi Bhatt, MS, MCh
Ignace de Hingh, MD, PhD
Kurt Van Der Speeten, MD, PhD
Martin Hubner, MD, PhD
Marcello Deraco, MD, PhD
Naoual Bakrin, MD, PhD
Laurent Villeneuve, MBE, PhD
Shigeki Kusamura, MD, PhD
Olivier Glehen, MD, PhD
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keyword: Cytostatic Therapy
Published in: Annals of Surgical Oncology / Issue 13/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-10193-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

HIPEC Methodology and Regimens: The Need for an Expert Consensus

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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