More evidence on benefits of HIPEC for recurrent ovarian cancer

Abstract

The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery significantly improved overall survival in comparison with cytoreductive surgery alone in platinum-sensitive patients with recurrent ovarian cancer, according to evidence from a randomized trial conducted by UNICANCER/CHIPOR investigators.¹

This is the first prospective, randomized evidence showing an improved survival benefit with the addition of HIPEC in patients undergoing complete cytoreductive surgery for their first late-relapsing ovarian cancer, say the authors led by Jean-Marc Classe, MD, PhD, surgeon and professor of oncology at the Institut de Cancérologie de l’Ouest.

The study found a nearly 10-month improvement in overall survival with the addition of HIPEC (cisplatin [75 mg/m²] in serum [2 L/m²] at 41 ±1°C for 60 min) to complete cytoreductive surgery. At a median follow-up of 6.2 years, patients treated with HIPEC plus cytoreductive surgery had a median overall survival of 54.3 months versus 45.8 months for those treated with cytoreductive surgery alone.

The results are based on 415 patients randomized to cytoreductive surgery alone (n = 208) or with HIPEC (n = 207) for first relapse of epithelial ovarian cancer. All patients had completed at least 6 months of platinum-based chemotherapy. The authors note that the trial population was highly chemosensitive, with approximately one half having a platinum-free interval of more than 19 months, most (three quarters) having a high-grade serous histology, and one quarter having the BRCA mutation.

“When treating patients with late first relapse of serous or high-grade serous or high-grade endometrioid ovarian cancer amenable to complete cytoreductive surgery at specialist centers, platinum-based HIPEC should be considered to extend overall survival,” state the authors.

Elise Kohn, MD, head of Gynecologic Cancer Therapeutics in the Cancer Therapy Evaluation Program at the National Cancer Institute, says, “I am not convinced about HIPEC and do not support it because there are so many biases in the trials, and it is difficult to dissect them.”

For example, she questions why HIPEC is effective. Could it be the heat? The intraperitoneal (location of) chemotherapy? “These trials never control for all variables,” she says.

“I think that oncologists should remain skeptical and only use HIPEC in the setting of a trial or only when being very transparent with a patient about what the evidence shows, that the patients involved had a very good prognosis altogether, and other issues such as toxicity,” Dr Kohn says.