Effect of intraperitoneal chemotherapy concentration on morbidity and survival

Elekonawo, Fortuné M.K.; Eden, W. J. van; Plas, Willemijn Y. van der; Ewalds, Roos S. G.; Jong, Loek de; Bremers, André J. A.; Hemmer, Patrick H. J.; Kok, N.F.M.; Kruijff, Schelto; Aalbers, Arend G. J.; Reuver, Philip R. de

doi:10.1002/bjs5.50250

Cited by 7 publications

(8 citation statements)

References 23 publications

(29 reference statements)

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“…Concentration-based protocols use a perfusate with a fixed chemotherapy concentration, leading to more predictable concentrations at the peritoneal surface, but possibly more variation in systemic exposure. One multicenter study 11 reported that variation in chemotherapy concentrations of the HIPEC perfusate did not affect postoperative complications or survival rates.…”

Section: Dosing and Durationmentioning

confidence: 99%

“…Approximately 25% of patients in the trial had a peritoneal cancer index of greater than 15, which has previously been reported as the threshold beyond which CRS-HIPEC is not beneficial. 60,76 In addition, subgroup analyses of the PRODIGE 7 data suggest a survival benefit of HIPEC in patients with intermediate extent of peritoneal metastases (peritoneal cancer index, [11][12][13][14][15].…”

Section: Current Role Of Hipec In the Treatment Of Colorectal Cancer ...mentioning

confidence: 99%

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Hyperthermic Intraperitoneal Chemotherapy for Ovarian and Colorectal Cancer

et al. 2021

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Section: Dosing and Durationmentioning

confidence: 99%

Section: Current Role Of Hipec In the Treatment Of Colorectal Cancer ...mentioning

confidence: 99%

Hyperthermic Intraperitoneal Chemotherapy for Ovarian and Colorectal Cancer

et al. 2021

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“…In four observational studies, the high-dose OX regimen was compared with high-dose MMC, with no difference in survival but more severe complications in OX-treated patients. 26 , 29 , 30 , 34 …”

Section: Resultsmentioning

confidence: 99%

2022 Peritoneal Surface Oncology Group International Consensus on HIPEC Regimens for Peritoneal Malignancies: Colorectal Cancer

Hübner,

van Der Speeten,

Govaerts

et al. 2023

Ann Surg Oncol

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Background Selected patients with peritoneal metastases of colorectal cancer (PM-CRC) can benefit from potentially curative cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC), with a median overall survival (OS) of more than 40 months. Objective The aims of this evidence-based consensus were to define the indications for HIPEC, to select the preferred HIPEC regimens, and to define research priorities regarding the use of HIPEC for PM-CRC. Methods The consensus steering committee elaborated and formulated pertinent clinical questions according to the PICO (patient, intervention, comparator, outcome) method and assessed the evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework. Standardized evidence tables were presented to an international expert panel to reach a consensus (4-point, weak and strong positive/negative) on HIPEC regimens and research priorities through a two-round Delphi process. The consensus was defined as ≥ 50% agreement for the 4-point consensus grading or ≥ 70% for either of the two combinations. Results Evidence was weak or very weak for 9/10 clinical questions. In total, 70/90 eligible panelists replied to both Delphi rounds (78%), with a consensus for 10/10 questions on HIPEC regimens. There was strong negative consensus concerning the short duration, high-dose oxaliplatin (OX) protocol (55.7%), and a weak positive vote (53.8–64.3%) in favor of mitomycin-C (MMC)-based HIPEC (preferred choice: Dutch protocol: 35 mg/m2, 90 min, three fractions), both for primary cytoreduction and recurrence. Determining the role of HIPEC after CRS was considered the most important research question, regarded as essential by 85.7% of the panelists. Furthermore, over 90% of experts suggest performing HIPEC after primary and secondary CRS for recurrence > 1 year after the index surgery. Conclusions Based on the available evidence, despite the negative results of PRODIGE 7, HIPEC could be conditionally recommended to patients with PM-CRC after CRS. While more preclinical and clinical data are eagerly awaited to harmonize the procedure further, the MMC-based Dutch protocol remains the preferred regimen after primary and secondary CRS.

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“…The concentrations were 0.045%, 0.06%, 0.09%, 0.135% and 0.18%, respectively. Oxaliplatin (Medoxa, medac GmbH, Wedel, Germany) was diluted in 5% glucose solution [ 27 , 28 ]. The concentration in each well was 0.24 mg/ml (= 0,6 mmol/L) which corresponds to common HIPEC application amounts of 960 mg/4 L (480 mg/m 2 ).…”

Section: Methodsmentioning

confidence: 99%

Exploring the potential of taurolidine in inducing mobilization and detachment of colon cancer cells: a preliminary in-vitro study

Mikołajczyk

Khosrawipour

Lau

et al. 2022

BMC Pharmacol Toxicol

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Background Recently, taurolidine has been intensively studied on a variety of in-vitro cancer cell-lines and first data exhibit encouraging antitumoral effects. While the clinical use of taurolidine is considered, some studies with in-vivo experiments contradict this beneficial effect and even indicate advanced cancer growth. The aim of this study is to further investigate this paradox in-vivo effect by taurolidine and closely analyze the interaction of cancer cells with the surrounding environment following taurolidine exposure. Methods HT-29 (ATCC® HTB-38™) cells were treated with taurolidine at different concentrations and oxaliplatin using an in-vitro model. Morphological changes with respect to increasing taurolidine dosage were visualized and monitored using electron microscopy. Cytotoxicity of the agents as well as extent of cellular detachment by mechanical stress was measured for each substance using a colorimetric MTS assay. Results Both taurolidine and oxaliplatin exhibit cell toxicity on colon cancer cells. Taurolidine reshapes colon cancer cells from round into spheric cells and further induces cluster formation. When exposed to mechanical stress, taurolidine significantly enhances detachment of adherent colon carcinoma cells compared to the control (p < 0.05) and the oxaliplatin group (p < 0.05). This effect is dose dependent. Conclusions Beside its cytotoxic effects, taurolidine could also change mechanical interactions of cancer cells with their environment. Local cancer cell conglomerates could be mechanically mobilized and may cause metastatic growth further downstream. The significance of changes in cellular morphology caused by taurolidine as well as its interaction with the microenvironment must be further addressed in clinical cancer therapies. Further clinical studies are needed to evaluate both the safety and efficacy of taurolidine for the treatment of peritoneal surface malignancies.

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Effect of intraperitoneal chemotherapy concentration on morbidity and survival

Cited by 7 publications

References 23 publications

Hyperthermic Intraperitoneal Chemotherapy for Ovarian and Colorectal Cancer

Hyperthermic Intraperitoneal Chemotherapy for Ovarian and Colorectal Cancer

2022 Peritoneal Surface Oncology Group International Consensus on HIPEC Regimens for Peritoneal Malignancies: Colorectal Cancer

Exploring the potential of taurolidine in inducing mobilization and detachment of colon cancer cells: a preliminary in-vitro study

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