Top Line: Does hyperthermic intra-peritoneal chemotherapy (HIPEC) improve survival when added to cytoreductive surgery in patients with colon cancer peritoneal metastases?
The Study: HIPEC has been associated with good disease and survival outcomes. But some wonder whether the outcomes seen with HIPEC are in-part due to selection of favorable patients and disease characteristics that lend themselves to the procedure. It is also uncertain if the perceived benefit of HIPEC persists in the setting of more effective multi-agent chemotherapy regimens. PRODIGE 7 was a phase 3 French study that randomized 265 patients with a complete macroscopic resection of peritoneal metastases from colorectal cancer to cytoreduction alone or followed by oxaliplatin-based HIPEC. They also received 6 months of standard perioperative chemotherapy (physicians choice). As shown at ASCO 2018, the full manuscript confirms no difference in median OS (41.7 vs 41.2 months) between arms. Thirty-day mortality and complications were similar, but at 60 days there were significantly more grade 3+ complications after HIPEC (15→ 26%). A small subset analysis suggested patients with a higher burden of peritoneal disease, determined by a higher peritoneal cancer index (PCI) score, may have benefited from HIPEC.
TBL: The addition of HIPEC to multi-agent chemo and cytoreductive surgery does not appear to improve survival in patients with colorectal cancer peritoneal metastases. | Quenet, Lancet Oncol 2021