Treating Late-Stage Ovarian Cancer with Heat
Despite multiple advancements made in chemotherapy, the overall chance of chemotherapy being remedial is still low and the side effects are difficult for patients to endure. However, when ovarian cancer is confined to the peritoneal cavity, theoretically this makes the disease an ideal target for high doses of hyperthermic intraperitoneal chemotherapy (HIPEC).
HIPEC is a highly concentrated solution containing heated chemotherapy that is delivered directly to the abdominal cavity during surgery. As opposed to systemic chemotherapy, which circulates to nearly every area of the body, HIPEC treatment involves the delivery of chemotherapy directly to the cancerous cells found within the abdomen.
The heated chemotherapy solution:
- Improves absorption of the chemotherapy drugs
- Enhances and concentrates the chemotherapy within the abdomen
- Eliminates any microscopic cancerous cells remaining in the abdomen following surgery
- Minimizes the rest of the body’s exposure to the chemotherapy
- Reduces a few chemotherapy side effects
Before a patient can undergo HIPEC treatment, the doctor needs to perform cytoreductive surgery in order to remove visible tumors within the abdomen. Once as many of the visible tumors as possible have been removed, the heated chemotherapy solution, which is at just over 100 degrees Fahrenheit, is delivered to the abdomen to eliminate any cancerous cells that remain. It circulates within the abdomen for approximately an hour and a half before it is drained from the abdomen and the incision is closed.
The promising role of HIPEC
A recent study, published in the New England Journal of Medicine, analyzed the difference between two treatments - cytoreductive surgery and cytoreductive surgery with added HIPEC treatment – for patients recently diagnosed with stage III epithelial ovarian cancer. 89% of the patients who were randomly assigned to cytoreductive surgery without added HIPEC treatment experienced a recurrence or passed away, while 81% of the patients who were randomly assigned to cytoreductive surgery with added HIPEC treatment experienced either of those outcomes. The HIPEC procedure involved delivery of the heated chemotherapy solution with 100mg of cisplatin.
In regards to the side effects experienced, the patients in the surgery group were slightly more likely to report anemia (5% vs. 1%); however, the patients in the HIPEC group experienced more infection (6% vs. 2%) and ileus (4% vs. 2%). The researchers noticed no significant differences between the two groups in terms of health-related quality of life outcomes over time.
The median rate of recurrence free survival for the first group and the second group was 10.7 months and 14.2 months, respectively. Moreover, the median rate of ovarian survival for the first group and the second group was 33.9 months and 45.7 months, respectively.
“The effect was consistent across the levels of prespecified stratification factors and other baseline characteristics. Intraperitoneal delivery of chemotherapy enhances drug delivery at the peritoneal surface and may improve outcomes by eliminating residual microscopic peritoneal disease more efficiently than intravenous administration of chemotherapy,” wrote Willemien J. van Driel, first author of the study, and fellow colleagues.
Read on to learn more about this revolutionary cancer therapy.