Inflammatory Response and Toxicity After Pressurized IntraPeritoneal Aerosol Chemotherapy

Abstract

Background: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a novel mode of intraperitoneal (IP) drug delivery claiming high IP tissue concentrations with low systemic uptake. The aim was to study inflammatory response and systemic toxicity after PIPAC.Methods: Retrospective monocentric analysis of a consecutive cohort of PIPAC patients between January 2015 and April 2016. Detailed hematological and biochemical analysis was performed the day before surgery and once daily until discharge. Comparative statistics were performed using Mann-Whitney U test and Wilcoxon signed ranked test.Results: Fourty-two consecutive patients underwent a total of 91 PIPAC procedures. Twenty patients received oxaliplatin and 22 cisplatin+doxorubicin (37 vs. 54 procedures). Creatinine, AST and ALT were not significantly altered after PIPAC (p=0.095, p= p=0.153 and p=0.351) and not different between oxaliplatin and cisplatin+doxorubicin regimens (p=0.371, p=0.251 and p=0.288). C-reactive protein (CRP) and procalcitonin (PCT) increased on post-operative day (POD) 2: ∆max 29±5 mg/L (p<0.001) and ∆max 0.05±0.01 μg/L (p=0.005), respectively. Leucocytes increased at POD 1: ∆max 2.2±0.3 G/L (p<0.001). Albumin decreased at POD 2: ∆max -6.0±0.5 g/L (p<0.001). CRP increase correlated positively with Peritoneal Cancer Index (tumor load) (ρ =0.521, p<0.001).Conclusion: PIPAC was followed by a modest and transitory inflammatory response that was commensurate to the disease extent. No hematological, renal or hepatic toxicity was observed even after repetitive administration.

Pressurized intraperitoneal aerosol chemotherapy: a review of the introduction of a new surgical technology using the IDEAL framework

“…Overall, the search identified: 23 stage 0 studies; 18 stage 1 studies and two protocol papers for stage 1 studies; 25 stage 2a studies, one protocol paper and five trial registrations (NCT01854255, NCT02735928, NCT03246321, NCT02604784 and NCT03124394) for stage 2a studies; six stage 2b studies and three protocol papers for stage 2b studies; and three protocol papers for stage 3 studies. Fig .…”

Anaesthesia in a Toxic Environment: Pressurised Intraperitoneal Aerosol Chemotherapy: A Retrospective Analysis

“…The chemotherapy regimens currently proposed are oxaliplatin alone for colorectal cancer and doxorubicin and cisplatin for PCs of other origins. Platinum agents may induce anaphylactic reactions and can irritate the eyes, skin and airways; they are toxic to the kidneys and bone marrow ( 14 , 15 ). Doxorubicin provokes mucosal inflammation, leukopenia and dilated cardiomyopathy.…”

Repetitive electrostatic pressurised intraperitoneal aerosol chemotherapy (ePIPAC) with oxaliplatin as a palliative monotherapy for isolated unresectable colorectal peritoneal metastases: protocol of a Dutch, multicentre, open-label, single-arm, phase II study (CRC-PIPAC)

“…However, the vast majority of these studies reported outcomes of entire cohorts that received repetitive PIPAC with various drugs for PM of various origins without presenting subgroup analyses of patients who received PIPAC-OX for colorectal PM 27–34. Only two studies reported separate outcomes of repetitive PIPAC-OX for colorectal PM 35 36. By using a prospectively maintained database, Teixeira Farinha et al retrospectively included 20 patients with isolated colorectal PM who received 37 procedures 35.…”

“…Only two studies reported separate outcomes of repetitive PIPAC-OX for colorectal PM 35 36. By using a prospectively maintained database, Teixeira Farinha et al retrospectively included 20 patients with isolated colorectal PM who received 37 procedures 35. They concluded that repetitive PIPAC-OX causes a modest and transitory inflammatory response without haematological, renal or hepatic toxicity 35.…”

“…By using a prospectively maintained database, Teixeira Farinha et al retrospectively included 20 patients with isolated colorectal PM who received 37 procedures 35. They concluded that repetitive PIPAC-OX causes a modest and transitory inflammatory response without haematological, renal or hepatic toxicity 35. Demtröder et al retrospectively included 17 patients with isolated colorectal PM who received 48 procedures within an off-label programme 36.…”