Advances with pharmacotherapy for peritoneal metastasis

ABSTRACT

Introduction

A new treatment strategy involving cytoreductive surgery (CRS) combined with perioperative intraperitoneal (IP) chemotherapy was proposed in 1999 by the Peritoneal Surface Oncology Group International, and the strategy is now justified as a state-of-the-art treatment to improve the long-term survival of patients with peritoneal metastasis (PM). To achieve cure in the patients with PM, complete removal of macroscopic tumors and eradication of micrometastasis on the peritoneum, left after CRS are essential. Systemic chemotherapy is not indicated for the treatment of PM. In contrast, intraperitoneal (IP) chemotherapy brings about significantly higher locoregional dose intensity in the peritoneal cavity and subperitoneal tissues.

In combination with anticancer drugs, hyperthermia enhances cytotoxicity against cancer cells.

Area covered

This article provides a systematic overview of PM from various cancers including gastric, colorectal, small bowel, appendiceal cancer, and mesothelioma. It also includes all the essential aspects of therapy.

Expert opinion

CRS plus perioperative intraperitoneal chemotherapy is safe with acceptable morbidity and mortality. It is justified as a standard treatment to improve the long-term survival of patients with PM and is now performed with curative intent for PM from various malignancies.

KEYWORDS:

• Cytoreductive surgery
• hipec
• intraperitoneal chemotherapy
• peritoneal metastasis
• peritonectomy
• pharmacokinetics

Article highlights

• A new treatment strategy involving cytoreductive surgery (CRS), combined with perioperative chemotherapy (POC) for peritoneal metastasis (PM) is justified as a standard therapy to improve the long-term survival of patients with PM.

• The treatment is indicated for PM from various abdominal malignancies.

• Complete cytoreduction combined with POC and peritoneal cancer index (PCI) less than threshold levels in each disease are essential for the cure of patients with PM

• If the microscopic burden left after CRS is smaller than the threshold level, intraoperative hyperthermic intraperitoneal chemo-perfusion may completely eliminate the residual micrometastasis.

• Micrometastasis burden outside the surgical field by CRS should be reduced at less than the threshold level by preoperative IP chemotherapy.

• Intraperitoneal (IP) chemotherapy using taxanes is recommended for preoperative chemotherapy, because it generates significantly higher IP dose intensity than other drugs.

This box summarizes key points contained in the article.

Annotation

HIPEC; hyperthermic intraperitoneal chemoperfusion

NIPS; neoadjuvant intraperitoneal/systemic chemotherapy

CRS; cytoreductive surgery

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationship to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This manuscript has not been funded.