Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical & Experimental Metastasis
Published in: Clinical & Experimental Metastasis 5/2017

01-06-2017 | Research Paper

Peritoneal metastasis from pancreatic cancer treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Authors: Martin Graversen, Sönke Detlefsen, Jon Kroll Bjerregaard, Per Pfeiffer, Michael Bau Mortensen

Published in: Clinical & Experimental Metastasis | Issue 5/2017

Login to get access

Abstract

Patients with peritoneal metastasis (PM) from pancreatic cancer have a short life expectancy. Systemic combination chemotherapy leads to a median overall survival of 7–8 months. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a treatment alternative, where studies in patients with PM from ovarian, gastric and colorectal cancer show a high safety profile and interesting results. This case study report data on the PIPAC treatment in patients with PM from pancreatic cancer. In a standard laparoscopy, chemotherapeutics (cisplatin and doxorubicin) are nebulized within the peritoneal cavity. After 30 min, the chemotherapeutics are evacuated through a closed system. The PIPAC procedure is repeated every 4–6 weeks. Five patients with PM from pancreatic cancer were treated with a total of 16 PIPAC procedures. All patients received >1 PIPAC and were eligible for evaluation of histological regression. Four patients demonstrated histological regression, and one patient had stable disease. Three patients are still alive, and the median overall survival is 14 months (range 10–20) since the diagnosis of PM. The histological regression and survival figures in this pilot study suggest activity of PIPAC with low-dose cisplatin and doxorubicin in pretreated peritoneal metastasis of pancreatic origin. This should now be evaluated in prospective studies.
Literature
1.
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49:1374–1403CrossRefPubMed
2.
Bjerregaard JK, Mortensen MB, Pfeiffer P (2016) Trends in cancer of the liver, gall bladder, bile duct, and pancreas in elderly in Denmark, 1980–2012. Acta Oncol 55(Suppl 1):40–45CrossRefPubMed
3.
Coupland VH, Konfortion J, Jack RH et al (2016) Resection rate, hospital procedure volume and survival in pancreatic cancer patients in England: population-based study, 2005–2009. Eur J Surg Oncol 42:190–196CrossRefPubMed
4.
5.
House MG, Gonen M, Jarnagin WR et al (2007) Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg 11:1549–1555CrossRefPubMed
6.
Sohn TA, Yeo CJ, Cameron JL et al (2000) Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4:567–579CrossRefPubMed
7.
Lim JE, Chien MW, Earle CC (2003) Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 237:74–85CrossRefPubMedPubMedCentral
8.
Richter A, Niedergethmann M, Sturm JW et al (2003) Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg 27:324–329CrossRefPubMed
9.
Gillen S, Schuster T, Meyer Zum Buschenfelde C et al (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7:e1000267CrossRefPubMedPubMedCentral
10.
Sudo K, Ishihara T, Hirata N et al (2014) Randomized controlled study of gemcitabine plus S-1 combination chemotherapy versus gemcitabine for unresectable pancreatic cancer. Cancer Chemother Pharmacol 73:389–396CrossRefPubMed
11.
Tabernero J, Chiorean EG, Infante JR et al (2015) Prognostic factors of survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer. Oncologist 20:143–150CrossRefPubMedPubMedCentral
12.
Bjerregaard JK, Mortensen MB, Schonnemann KR, Pfeiffer P (2013) Characteristics, therapy and outcome in an unselected and prospectively registered cohort of pancreatic cancer patients. Eur J Cancer 49:98–105CrossRefPubMed
13.
Sadeghi B, Arvieux C, Glehen O et al (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363CrossRefPubMed
14.
Thomassen I, Lemmens VE, Nienhuijs SW et al (2013) Incidence, prognosis, and possible treatment strategies of peritoneal carcinomatosis of pancreatic origin: a population-based study. Pancreas 42:72–75CrossRefPubMed
15.
Sugarbaker PH (1998) Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 14:254–261CrossRefPubMed
16.
Solass W, Kerb R, Murdter T et al (2014) Intraperitoneal chemotherapy of peritoneal carcinomatosis using pressurized aerosol as an alternative to liquid solution: first evidence for efficacy. Ann Surg Oncol 21:553–559CrossRefPubMed
17.
Solass W, Giger-Pabst U, Zieren J, Reymond MA (2013) Pressurized intraperitoneal aerosol chemotherapy (PIPAC): occupational health and safety aspects. Ann Surg Oncol 20:3504–3511CrossRefPubMedPubMedCentral
18.
Graversen M, Pedersen PB, Mortensen MB (2016) Environmental safety during the administration of pressurized intraperitoneal aerosol chemotherapy. Pleura and Peritoneum 1(4):203–208CrossRef
19.
Blanco A, Giger-Pabst U, Solass W et al (2013) Renal and hepatic toxicities after pressurized intraperitoneal aerosol chemotherapy (PIPAC). Ann Surg Oncol 20:2311–2316CrossRefPubMedPubMedCentral
20.
Tempfer CB, Celik I, Solass W et al (2014) Activity of pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin in women with recurrent, platinum-resistant ovarian cancer: preliminary clinical experience. Gynecol Oncol 132:307–311CrossRefPubMed
21.
Tempfer CB, Winnekendonk G, Solass W et al (2015) Pressurized intraperitoneal aerosol chemotherapy in women with recurrent ovarian cancer: a phase 2 study. Gynecol Oncol 137:223–228CrossRefPubMed
22.
Nadiradze G, Giger-Pabst U, Zieren J et al (2016) Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with low-dose cisplatin and doxorubicin in gastric peritoneal metastasis. J Gastrointest Surg 20:367–373CrossRefPubMed
23.
Demtroder C, Solass W, Zieren J et al (2016) Pressurized intraperitoneal aerosol chemotherapy with oxaliplatin in colorectal peritoneal metastasis. Colorectal Dis 18:364–371CrossRefPubMed
24.
Solass W, Hetzel A, Nadiradze G et al (2012) Description of a novel approach for intraperitoneal drug delivery and the related device. Surg Endosc 26:1849–1855CrossRefPubMed
25.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral
26.
Solass W, Detlefsen S, Carr N et al (2016) Peritoneal sampling and histological assessment of therapeutic response in peritoneal metastasis: proposal of the Peritoneal Regression Grading Score (PRGS). Pleura and Peritoneum 1(2):99–107CrossRef
27.
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefPubMed
28.
Takahara N, Isayama H, Nakai Y et al (2016) Intravenous and intraperitoneal paclitaxel with S-1 for treatment of refractory pancreatic cancer with malignant ascites. Invest New Drugs 34:636–642CrossRefPubMed
29.
Oman M, Blind PJ, Naredi P et al (2001) Treatment of non-resectable pancreatic cancer with intraperitoneal 5-FU and leucovorin IV. Eur J Surg Oncol 27:477–481CrossRefPubMed
30.
Flessner MF (2005) The transport barrier in intraperitoneal therapy. Am J Physiol Renal Physiol 288:F433–F442CrossRefPubMed
31.
Jacquet P, Stuart OA, Chang D, Sugarbaker PH (1996) Effects of intra-abdominal pressure on pharmacokinetics and tissue distribution of doxorubicin after intraperitoneal administration. Anticancer Drugs 7:596–603CrossRefPubMed
32.
Solass W, Herbette A, Schwarz T et al (2012) Therapeutic approach of human peritoneal carcinomatosis with Dbait in combination with capnoperitoneum: proof of concept. Surg Endosc 26:847–852CrossRefPubMed
33.
Reymond MA (2014) PIPAC pressurized intraperitoneal aerosol chemotherapy—Cancer under pressure. Walter de Gruyter, Berlin
Metadata
Title
Peritoneal metastasis from pancreatic cancer treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC)
Authors
Martin Graversen
Sönke Detlefsen
Jon Kroll Bjerregaard
Per Pfeiffer
Michael Bau Mortensen
Publication date
01-06-2017
Publisher
Springer Netherlands
Published in
Clinical & Experimental Metastasis / Issue 5/2017
Print ISSN: 0262-0898
Electronic ISSN: 1573-7276
DOI
https://doi.org/10.1007/s10585-017-9849-7

Other articles of this Issue 5/2017

Clinical & Experimental Metastasis 5/2017 Go to the issue

Research Paper

Is the non-sentinel lymph node compartment the next site for melanoma progression from the sentinel lymph node compartment in the regional nodal basin?

Research Paper

Portal branch ligation does not counteract the inhibiting effect of temsirolimus on extrahepatic colorectal metastatic growth

Research Paper

Expression of ezrin and moesin in primary breast carcinoma and matched lymph node metastases

Research Paper

Next generation sequencing of progressive colorectal liver metastases after portal vein embolization

Review Article

The pathogenesis, diagnosis, and management of metastatic tumors to the ovary: a comprehensive review

Research Paper

Patterns of metastatic progression after definitive radiation therapy for early-stage and locally advanced non-small cell lung cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits