What is Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?

From the Guidelines

HIPEC should be considered as an option for patients with stage III ovarian cancer who have undergone neoadjuvant chemotherapy and have response or stable disease after 3 cycles of treatment. This recommendation is based on the most recent and largest phase III prospective comparative study, M06OVH-OVHIPEC, which showed that HIPEC improved recurrence-free survival and overall survival in patients with FIGO stage III primary epithelial ovarian, fallopian tube, or peritoneal cancer who underwent neoadjuvant chemotherapy due to extensive abdominal disease or suboptimal primary debulking surgery 1.

Key Points to Consider

• HIPEC is a technique that delivers heated chemotherapy directly into the peritoneal cavity, which can increase the effectiveness of the treatment by enhancing drug penetration and cancer cell killing 1.
• The procedure involves cytoreductive surgery to remove visible tumors, followed by the circulation of heated chemotherapy drugs throughout the abdominal cavity for about 90 minutes 1.
• Patient selection is crucial, and HIPEC is typically recommended for patients with high-volume intraperitoneal disease who are at risk for widespread residual microscopic disease even after resection to no visible disease 1.
• The NCCN Guidelines now include an option to consider HIPEC at the time of interval debulking surgery in patients with stage III disease treated with neoadjuvant chemotherapy 1.

Potential Benefits and Risks

• HIPEC has been shown to improve recurrence-free survival and overall survival in select patients with ovarian cancer 1.
• However, the procedure is associated with significant risks, including major/severe complications such as fistulas, abscesses, and infections, as well as potential long-term effects on quality of life 1.
• The decision to undergo HIPEC should be made on a case-by-case basis, taking into account the individual patient's disease characteristics, overall health, and potential benefits and risks of the procedure 1.

From the Research

HIPEC Overview

• Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a treatment approach for peritoneal cancers, involving the delivery of chemotherapy directly into the abdominal cavity at high temperatures 2, 3, 4.
• The goal of HIPEC is to achieve high intracellular drug concentrations at the peritoneal surface, targeting cancer cells that have spread to the peritoneum 4.

Indications for HIPEC

• For patients with newly diagnosed stage III primary epithelial ovarian or fallopian tube carcinoma, or primary peritoneal carcinoma, HIPEC should be considered for those with at least stable disease after neoadjuvant chemotherapy at the time of interval cytoreductive surgery (CRS) if complete or optimal cytoreduction is achieved 2, 3, 5.
• There is insufficient evidence to recommend the addition of HIPEC when primary CRS is performed for patients with newly diagnosed advanced primary epithelial ovarian or fallopian tube carcinoma, or primary peritoneal carcinoma, outside of a clinical trial 2, 3.
• HIPEC may be considered for patients with stage III ovarian cancer who undergo interval debulking surgery after neoadjuvant chemotherapy, as part of first-line therapy 5.

Efficacy and Safety of HIPEC

• Evidence from a randomized trial shows improved recurrence-free and overall survival after HIPEC in patients with ovarian cancer who are ineligible for primary CRS 4.
• Toxic effects of HIPEC are limited, and the procedure is generally considered safe 4.
• The role of HIPEC in colorectal cancer is less well defined, and future studies are needed to tailor patient selection, timing, and optimal regimens of HIPEC to improve its effectiveness 4.

Ongoing Research and Future Directions

• A randomized controlled trial (the NHIPEC trial) is currently underway to evaluate the efficacy of neoadjuvant HIPEC in advanced high-grade serous ovarian cancer 6.
• The trial aims to compare the combination of neoadjuvant HIPEC and intravenous chemotherapy with intravenous chemotherapy alone, with a primary endpoint of achieving a Chemotherapy Response Score (CRS) of 3 6.