Madrid, 15 February 2024. Seventy-five percent of ovarian cancer patients will develop peritoneal carcinamatosis, a dissemination of cancerous cells in the interior of the abdominal and pelvic cavity that become detached from the primary tumour. A comprehensive approach to peritoneal carcinamatosis in advanced cases of ovarian cancer has been a topic for debate among gynaecological and surgical oncology teams, especially in relation to the role played by hyperthermic intraperitoneal chemotherapy (HIPEC) in surgical intervention following complete cytoreductive surgery, as a possible better therapeutic option for curative purposes.
In this context, and with the aim of further examining the efficiency and routine application of this method, MD Anderson Cancer Center Madrid has hosted an international Workshop entitled “Management of Peritoneal Carcinamatosis in Advanced Ovarian Cancer. The HIPEC question”. This technique has been supported over recent years by the OVHIPEC-1(1) and CHIPOR(2) randomised phase III trials, which have demonstrated the potential effectiveness of HIPEC in two scenarios related to ovarian cancer: interval surgery following systemic neoadjuvant chemotherapy and peritoneal relapse in platinum-sensitive ovarian cancer.
Complementary treatment to complete cytoreduction.
To date, the role of HIPEC in the treatment of ovarian cancer after complete cytoreduction has been the subject of controversy due to a lack of definitive studies or adequate scientific evidence to confirm its possible effectiveness. However, these recent studies have shown how it can work in certain situations for patients suffering from ovarian cancer with peritoneal carcinamatosis who were given HIPEC treatment following complete cytoreduction, resulting in significantly greater survival times, compared with those who only received complete cytoreduction.
“I firmly believe HIPEC can be a useful technique, but not in all cases. At the moment no study has been able to definitively identify in which cases it is most effective”, explained Dr. Javier de Santiago, Head of the Gynaecological Oncology Department at MD Anderson Madrid, who emphasised that “not all cancers are the same, nor all patients”.
“Not all treatments work as well for all patients, and there are alternatives that we are currently using, such as PARP inhibitors and immunotherapy. At this open day we have been pleased to welcome the chief researchers on these studies, Dr. Willemien Van Driel, from the Netherlands Cancer Institute, in Amsterdam, and Dr. Jean Marc Classe, of the Institute de Cancérologie de l’Ouest, Sant Herblain, Nantes, enabling us to hear their opinions as there are still many aspects that need clarifying”, he added. Likewise, Dr. Gwenaël Ferron, from the Toulouse Institut Universitaire du Cancer, joined the forum to provide an additional insight on this topic of interest.
Application of HIPEC following complete cytoreduction
For his part, Dr. Santiago González, Medical Director at MD Anderson Madrid and Head of the Surgical Oncology Department, showed that he was in favour of applying hyperthermic intraperitoneal chemotherapy after complete cytoreduction.
In the doctor’s view, “adequate cytoreduction is essential in ovarian cancer. It is the primary treatment in cases of advanced ovarian cancer, as it eliminates those tumour implants that are visible to the naked eye”. Dr. Gonzalez then went on to explain how “the second part of this process is hyperthermic intraperitoneal chemotherapy to destroy those microscopic residues that remain in the abdominal cavity and which can lead to a relapse in the future”.
“The OVHIPEC-1 and CHIPOR trials”, continued the specialist, “mark a turning point in our understanding of the role HIPEC can play in advanced ovarian cancer, demonstrating that combining this technique with a complete cytoreduction can translate into better overall survival rates, free from the disease”.
Nevertheless, the experts warned that there is still a lot of work required in this field, which is why they are continuing to study and evaluate the use of HIPEC in various clinical contexts. These include application following primary cytoreduction, the object of the OVHIPEC-2 clinical trials currently underway, as its leader Dr. van Driel explained. “With this international Workshop we have also sought to emphasise the importance of collaboration between gynaecological and surgical oncology teams in order to prolong the life of these patients and improve their quality of life”, concluded the MD Anderson Madrid Medical Director.
References:
- Aronson SL et al. Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy in patients with advanced ovarian cancer (OVHIPEC-1): final survival analysis of a randomised, controlled, phase 3 trial. The Lancet Oncology 2023; 24 (10): 1109-18. DOI: https://doi.org/10.1016/S1470-2045(23)00396-0
- Classe JM et al. Hyperthermic intraperitoneal chemotherapy in platinum-sensitive relapsed epithelial ovarian cancer: The CHIPOR randomized phase III trial. ASCO 2023 Abstract #5510
Caption (from left to right): Dr. Santiago González, Medical Director at MD Anderson Madrid and Head of the Surgical Oncology Department; Dr. Gwenaël Ferron, from the Toulouse Institut Universitaire du Cancer; Dr. Willemien van Driel, from the Netherlands Cancer Institute in Amsterdam, and Dr. Javier de Santiago, Head of the Gynaecological Oncology Department at MD Anderson Madrid.