PIPAC technique shows promise for unresectable colorectal peritoneal metastases

A recent, multicentre, single-arm, phase 2 trial has revealed promising results in the treatment of unresectable peritoneal metastasis from colorectal or appendiceal carcinoma, using the Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) approach. This innovative treatment strategy involves the application of chemotherapy via a specialised burn nebulizer, allowing for an evenly distributed mist within the abdominal cavity.

The CRC-PIPAC-II study, presented by Dr Vincent van de Vlasakker (Catharina Hospital, the Netherlands), included 20 patients undergoing a combined total of 52 bi-directional treatment cycles [1]. With an impressive 75% of patients successfully completing the trial treatment, the PIPAC approach demonstrated robust feasibility. “The dropout rate was low, with only 1 patient discontinuing due to toxicity,” Dr van de Vlasakker commented. “This suggests that our approach is not only feasible but also safe.”

In terms of efficacy, the trial reported encouraging results. The median progression-free survival was 10 months, while the median overall survival was 17.5 months. “These numbers are promising, especially when compared with the typical overall survival of 12 months observed with systemic therapy alone,” the study lead noted.

However, the trial’s results were not without complications. The impact on the patient’s quality of life was mixed. Adverse events included abdominal pain, peripheral neuropathy, nausea, vomiting, and fatigue. However, an improvement in emotional functioning was also observed. “Despite the safety of the treatment, it is crucial not to overlook its significant impact on patients’ lives,” Dr van de Vlasakker cautioned.

The overall conclusion from this trial was that the PIPAC technique represents an innovative leap in intra-peritoneal therapies, demonstrating that a high-dose, localised treatment strategy could improve outcomes for patients with advanced peritoneal metastases. However, the complexity and mixed impact on quality of life suggests that this approach should be reserved for carefully selected patients, while more research is needed to further refine and assess this technique.

1. van de Vlasakker V, et al. Outcomes of first-line palliative systemic therapy alternated with oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy in patients with unresectable colorectal peritoneal metastases in a multicenter, single-arm, phase II trial. Lecture 727, DDW 2023, 6–9 May, Chicago, IL, USA.

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