ASO Author Reflections: Which HIPEC Regimens Should be Used in Patients with Epithelial Ovarian Cancer? In the Clinic and in Randomized Trials

Excerpt

There is a strong therapeutic rationale for performing hyperthermic intraperitoneal chemotherapy (HIPEC) in epithelial ovarian cancer (EOC). A multitude of HIPEC regimens have been used in clinical practice with varying outcomes. The choice of drugs and regimens depended largely on the pharmacokinetic profile of the drug, as measures of therapeutic efficacy remained undefined. The OVHIPEC-1 trial favored the addition of HIPEC to interval cytoreductive surgery(iCRS), the KOVHIPEC-1 trial did not favor the use of HIPEC though the post hoc analysis showed a 14-month survival benefit in patients undergoing iCRS, and the Zivanovic carboplatin-HIPEC trial showed no benefit of HIPEC in patients undergoing secondary CRS.^1,2 The various merits and demerits of each trial aside, there is a concern about HIPEC regimen used as well: can another regimen produce the same results as the one used in a positive trial, and could a different regimen result in a therapeutic benefit that a particular regimen failed to demonstrate? Given the multitude of pharmacological and non-pharmacological factors that influence the efficacy of HIPEC, innumerable permutations and combinations are possible. Randomized trials comparing different regimens are the best but largely impossible way of limiting the number of HIPEC regimens that are used in the clinic and tested in trials. …