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HIPEC: Advancing Survivorship for GYN Cancer Patients
A team of cancer specialists at the Seidman Cancer Center at University Hospitals (UH) Case Medical Center in Cleveland, Ohio, is among the first in the nation to launch a dedicated gynecologic program using Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to treat ovarian, endometrial and select other malignancies.
The team, which includes medical and surgical oncologists, intensivists, perfusionists and chemotherapy nurses, is led by Robert DeBernardo, MD, a gynecologic oncologist and assistant professor at Case Western Reserve University School of Medicine. MD News recently asked Dr. DeBernardo about HIPEC and its advantages.
MD News: What is HIPEC, and how is it delivered?
Dr. DeBernardo: HIPEC has been used for years in patients with colon, pseudomyxomas and appendiceal cancers as well as mesothelioma, cancers that in general are not responsive to chemotherapy. Now it’s viewed as a promising new treatment for gynecologic cancers, including new and recurrent ovarian cancer and certain high-risk endometrial cancers.
HIPEC is delivered in the OR immediately after cancer surgery to attack any remaining malignant cells and delay or abate cancer growth. The procedure involves heating (to 42-44 degrees centigrade) a chemotherapy agent — such as Adriamycin, melphalan, mitomycin C, cisplatin, Taxol, bleomycin — and delivering it via a perfusion system into the abdominal cavity where the chemo agent circulates for up to 90 minutes, penetrating cancerous tissue. After the agent is removed, the area is flushed with a sterile saline solution.
MD News: What are the advantages of HIPEC over traditional IV chemotherapy?
Dr. DeBernardo: The main advantage is improved survival rates for gynecologic cancer patients. Previous national studies on the use of intraperitoneal (IP) chemotherapy to treat women with advanced ovarian cancer indicate these women live an average of 1.5 years longer than those receiving traditional intravenous (IV) chemotherapy.
There are many other advantages, as well. HIPEC has the ability to target hard-to-reach surfaces in the peritoneum. It can also allow a much higher dose of chemotherapy to permeate the cancerous tissue than IV chemotherapy which circulates throughout the body and is diluted by the time it reaches the abdomen.
Another advantage over IV therapy is HIPEC is regionalized chemotherapy — it’s delivered only where it’s needed, sparing healthy tissue and the rest of the body’s exposure to treatment. This helps reduce some side effects, such as hair loss. Additionally, research has demonstrated that heating a chemotherapeutic agent enhances its effectiveness, increasing cancer cell responsiveness.
The advantage over IP chemotherapy is that HIPEC is a one-time treatment — it’s delivered at the time of surgery. IP chemotherapy is delivered over multiple outpatient treatments, and there are complications associated with this.
MD News: UH is planning several research studies on HIPEC. What will they involve?
Dr. DeBernardo: We plan to launch four Phase One clinical trials on HIPEC this year. All will focus on morbidity, feasibility and patient tolerance to treatment and, of course, on outcomes.
Our first study is a first-of-its kind. It will involve the use of Hyperthermic Intrathoracic Chemotherapy (HITEC) for ovarian cancer that has spread to the thoracic cavity. After minimally invasive lung surgery, the heated chemotherapy will be circulated through the thoracic cavity.
A second study will involve ovarian cancer patients in remission who have completed the initial therapy of surgery and chemotherapy. These patients will undergo a limited, one-time IP chemoperfusion treatment to prevent recurrence.
A third study will include patients with oligometastatic disease that is not widespread, with HIPEC performed following surgical resection of the disease. And a fourth study will examine HIPEC as neoadjuvant chemotherapy . . . delivering HIPEC in the operating room immediately after surgery on patients who have already undergone several intravenous chemotherapy treatments.
MD News: What do you want physicians to know about HIPEC?
Dr. DeBernardo: HIPEC has a positive safety record; there is minimal risk to patients. Our preliminary data and experience show significantly lower morbidity. We’ve also found that patient tolerance is high.
Ideal candidates are women facing a recurrence of gynecologic cancer, including ovarian and endometrial cancer, or those who are looking for a preventive option after undergoing initial treatments.
In our battle against cancer, we keep developing novel methods to outsmart the disease, and HIPEC is yet another important tool in our war chest. We believe it can improve the odds for patients with gynecologic cancer.
To learn more about the HIPEC gynecologic program at UH Case Medical Center, physicians may contact Dr. Robert DeBernardo via email at UHHIPEC@UHhospitals.org or by calling (216) 844-3954.