From the Guidelines
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is not recommended as a standard treatment for pancreatic cancer due to its limited role and investigational status in this setting. HIPEC involves delivering heated chemotherapy directly into the abdominal cavity during surgery to target microscopic cancer cells that may remain after tumor removal. While HIPEC has shown some benefit in certain peritoneal malignancies like pseudomyxoma peritonei and selected colorectal cancer cases, its efficacy in pancreatic cancer remains uncertain 1. The primary challenges with pancreatic cancer are its aggressive biology, early systemic spread, and poor response to available chemotherapeutic agents.
Standard Treatment for Pancreatic Cancer
Standard treatment for pancreatic cancer typically includes:
- Surgical resection when possible
- Combined with systemic chemotherapy regimens such as FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) or gemcitabine plus nab-paclitaxel Some clinical trials are exploring HIPEC's potential role in selected pancreatic cancer patients, particularly those with limited peritoneal disease, but results have been inconsistent 1.
Considerations for HIPEC in Pancreatic Cancer
The significant morbidity associated with the combined procedure (cytoreductive surgery plus HIPEC) must be weighed against uncertain benefits. Patients interested in HIPEC for pancreatic cancer should be referred to specialized centers conducting clinical trials in this area. According to recent guidelines, systemic therapy is used in all stages of pancreatic cancer, including neoadjuvant, adjuvant, locally advanced unresectable, and metastatic disease 1.
Recent Guidelines and Studies
Recent studies and guidelines suggest that the role of HIPEC in pancreatic cancer is still experimental and not recommended for routine use 1. However, some studies suggest that HIPEC can be effective in scenarios with minimal residual disease 1.
Recommendation
Patients with pancreatic cancer should be treated with standard therapies, and those interested in HIPEC should be referred to specialized centers conducting clinical trials. The treatment of pancreatic cancer should be individualized, and patients should be encouraged to participate in clinical trials to improve outcomes 1.
From the Research
Role of HIPEC in Pancreatic Cancer
- The use of hyperthermic intraperitoneal chemotherapy (HIPEC) in pancreatic cancer has been investigated in several studies 2, 3, 4, 5.
- A systematic review and meta-analysis found that HIPEC could be considered a promising technique for prophylaxis and treatment of peritoneal metastasis in borderline resectable and locally advanced disease 3.
- The study also found that increased survival rates emerged without additional morbidity when surgical resection and cytoreductive surgery (CRS) are possible 3.
- Another study found that cytoreduction and HIPEC for selected patients with low-volume peritoneal metastasis from pancreatic ductal adenocarcinoma is safe and feasible with favorable short-term outcomes 5.
- The overall survival and progression-free survival rates varied across studies, with one study reporting a median overall survival of 26 months and a median progression-free survival of 20 months 5.
- However, the evidence is limited by the small sample size and low quality of the included studies, and further research is needed to justify the use of HIPEC as an adjuvant therapy in resectable pancreatic adenocarcinoma 2.
- Other treatments, such as the XELOXIRI regimen, have shown promising efficacy and manageable toxicity in the treatment of advanced pancreatic cancer, but are not directly related to the use of HIPEC 6.
Efficacy and Safety of HIPEC
- The efficacy and safety of HIPEC in pancreatic cancer have been evaluated in several studies, with varying results 2, 3, 5.
- One study found that the hospital mortality rate was 8.5% and morbidity was 34%, mainly attributed to anastomotic leak or respiratory failure 2.
- Another study found that HIPEC was associated with a survival rate of 24% at 3 years, with no additional morbidity when surgical resection and CRS are possible 3.
- The study also found that PIPAC and NIPEC as palliative treatment in unresectable disease seems to identify more favorable survival rates compared to literature 3.
Future Directions
- Further studies are needed to justify the use of HIPEC as an adjuvant therapy in resectable pancreatic adenocarcinoma 2.
- A phase II trial is currently enrolling to further assess the multimodality approach of cytoreduction and HIPEC in select patients with low-volume peritoneal metastasis from pancreatic ductal adenocarcinoma 5.
- The emerging role of cytoreduction and HIPEC in pancreatic cancer warrants further investigation, particularly in patients with oligometastatic disease isolated to the peritoneum 4.