Is pressurized intraperitoneal aerosol chemotherapy safe and effective in the treatment of peritoneal metastases from pancreatic adenocarcinoma?

Krzysztof Smoluchowski, Michał Sekuła, Blanka Świerczyńska, Adrian Undziakiewicz, Magdalena Suchodolska



Introduction and purpose: Pancreatic adenocarcinoma (PAC) is the third most common cancer of the gastrointestinal tract in the Western population. Peritoneal metastases (PM) affect 5-10% patients with PAC at the moment of diagnosis and 50% of patients who experience a recurrence after a successful resection. This review aims to evaluate the efficacy of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the treatment of PM from PAC based on the literature available on PubMed website

Brief description of the state of knowledge: PIPAC is a relatively new method of treatment and the number of studies investigating its application in the treatment of PM from PAC is scarce. Nevertheless, initial findings suggest that PIPAC is linked to 15,6 months of the median overall survival, while standard intravenous chemotherapy reaches only 7,6 months . Furthermore, PIPAC seems to be a fairly safe method, as no grade 3 or grade 4 complications (according to CTCAE v4.0) occurred. However, all of the studies involved an unrepresentative number of patients and they were not free from a selection bias. Moreover, due to the novelty of the PIPAC procedure, it still needs to be properly standardised. 

Conclusions: Available data concerning the application of PIPAC in the treatment of PM from PDAC is limited. Large prospective studies consisting of control groups are still lacking. Nevertheless, the results of accessible studies displaying a median OS of participants reaching 14-16,8 months, with no G3 and G4 complications, are encouraging and justify further research.


aerosol chemotherapy; pancreatic adenocarcinoma; peritoneal metastases; PIPAC

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Ferlay, J., Steliarova-Foucher, E., Lortet-Tieulent, J., Rosso, S., Coebergh, J., Comber, H., . . . Bray, F. (2013). Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. European Journal of Cancer, 49(6), 1374-1403. doi:10.1016/j.ejca.2012.12.027

Coupland, V., Konfortion, J., Jack, R., Allum, W., Kocher, H., Riaz, S., . . . Møller, H. (2016). Resection rate, hospital procedure volume and survival in pancreatic cancer patients in England: Population-based study, 2005–2009. European Journal of Surgical Oncology (EJSO), 42(2), 190-196. doi:10.1016/j.ejso.2015.11.003

Stark, A. P., Sacks, G. D., Rochefort, M. M., Donahue, T. R., Reber, H. A., Tomlinson, J. S., . . . Hines, O. J. (2016). Long-term survival in patients with pancreatic ductal adenocarcinoma. Surgery, 159(6), 1520-1527. doi:10.1016/j.surg.2015.12.024

Kwon, D., Mcfarland, K., Velanovich, V., & Martin, R. C. (2014). Borderline and locally advanced pancreatic adenocarcinoma margin accentuation with intraoperative irreversible electroporation. Surgery, 156(4), 910-922. doi:10.1016/j.surg.2014.06.058

Sleeman, J. P. (2017). PIPAC puts pressure on peritoneal metastases from pancreatic cancer. Clinical & Experimental Metastasis, 34(5), 291-293. doi:10.1007/s10585-017-9851-0

Broeck, A. V., Sergeant, G., Ectors, N., Steenbergen, W. V., Aerts, R., & Topal, B. (2009). Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. European Journal of Surgical Oncology (EJSO), 35(6), 600-604. doi:10.1016/j.ejso.2008.12.006

Sohn, T., Yeo, C., Cameron, J., Koniaris, L., Kaushal, S., Abrams, R., . . . Lillemoe, K. (2000). Resected adenocarcinoma of the pancreas?616 patients: Results, outcomes, and prognostic indicators. Journal of Gastrointestinal Surgery, 4(6), 567-579. doi:10.1016/s1091-255x(00)80105-5

Yamamoto, T. (2015). Long-term survival after resection of pancreatic cancer: A single-center retrospective analysis. World Journal of Gastroenterology, 21(1), 262. doi:10.3748/wjg.v21.i1.262

Smeenk, H. G., Tran, T. C., Erdmann, J., Eijck, C. H., & Jeekel, J. (2004). Survival after surgical management of pancreatic adenocarcinoma: Does curative and radical surgery truly exist? Langenbecks Archives of Surgery, 390(2), 94-103. doi:10.1007/s00423-004-0476-9

Tabernero, J., Chiorean, E. G., Infante, J. R., Hingorani, S. R., Ganju, V., Weekes, C., . . . Hoff, D. D. (2015). Prognostic Factors of Survival in a Randomized Phase III Trial (MPACT) of Weekly nab‐ Paclitaxel Plus Gemcitabine Versus Gemcitabine Alone in Patients With Metastatic Pancreatic Cancer. The Oncologist, 20(2), 143-150. doi:10.1634/theoncologist.2014-0394

Conroy, T., Desseigne, F., Ychou, M., Bouché, O., Guimbaud, R., Bécouarn, Y., . . . Ducreux, M. (2011). FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer. New England Journal of Medicine, 364(19), 1817-1825. doi:10.1056/nejmoa1011923

Lu, Z., Wang, J., Wientjes, M. G., & Au, J. L. (2010). Intraperitoneal therapy for peritoneal cancer. Future Oncology, 6(10), 1625-1641. doi:10.2217/fon.10.100

Olive, K. P., Jacobetz, M. A., Davidson, C. J., Gopinathan, A., Mcintyre, D., Honess, D., . . . Tuveson, D. A. (2009). Inhibition of Hedgehog Signaling Enhances Delivery of Chemotherapy in a Mouse Model of Pancreatic Cancer. Science, 324(5933), 1457-1461. doi:10.1126/science.1171362

Chua, T. C., Yan, T. D., Saxena, A., & Morris, D. L. (2009). Should the Treatment of Peritoneal Carcinomatosis by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Still be Regarded as a Highly Morbid Procedure? Annals of Surgery, 249(6), 900-907. doi:10.1097/sla.0b013e3181a45d86

Esquis, P., Consolo, D., Magnin, G., Pointaire, P., Moretto, P., Ynsa, M. D., . . . Chauffert, B. (2006). High Intra-abdominal Pressure Enhances the Penetration and Antitumor Effect of Intraperitoneal Cisplatin on Experimental Peritoneal Carcinomatosis. Annals of Surgery, 244(1), 106-112. doi:10.1097/01.sla.0000218089.61635.5f

Solass, W., Kerb, R., Mürdter, T., Giger-Pabst, U., Strumberg, D., Tempfer, C., . . . Reymond, M. A. (2013). Intraperitoneal Chemotherapy of Peritoneal Carcinomatosis Using Pressurized Aerosol as an Alternative to Liquid Solution: First Evidence for Efficacy. Annals of Surgical Oncology, 21(2), 553-559. doi:10.1245/s10434-013-3213-1

Tempfer, C. B., Winnekendonk, G., Solass, W., Horvat, R., Giger-Pabst, U., Zieren, J., . . . Reymond, M. (2015). Pressurized intraperitoneal aerosol chemotherapy in women with recurrent ovarian cancer: A phase 2 study. Gynecologic Oncology, 137(2), 223-228. doi:10.1016/j.ygyno.2015.02.009

Struller, F., Horvath, P., Solass, W., Weinreich, F., Strumberg, D., Kokkalis, M. K., . . . Reymond, M. A. (2019). Pressurized intraperitoneal aerosol chemotherapy with low-dose cisplatin and doxorubicin (PIPAC C/D) in patients with gastric cancer and peritoneal metastasis: A phase II study. Therapeutic Advances in Medical Oncology, 11, 175883591984640. doi:10.1177/1758835919846402

Graversen, M., Detlefsen, S., Bjerregaard, J. K., Pfeiffer, P., & Mortensen, M. B. (2017). Peritoneal metastasis from pancreatic cancer treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC). Clinical & Experimental Metastasis, 34(5), 309-314. doi:10.1007/s10585-017-9849-7

Khosrawipour, T., Khosrawipour, V., & Giger-Pabst, U. (2017). Pressurized Intra Peritoneal Aerosol Chemotherapy in patients suffering from peritoneal carcinomatosis of pancreatic adenocarcinoma. Plos One, 12(10). doi:10.1371/journal.pone.0186709

Horvath, P., Beckert, S., Struller, F., Königsrainer, A., & Reymond, M. A. (2018). Pressurized intraperitoneal aerosol chemotherapy (PIPAC) for peritoneal metastases of pancreas and biliary tract cancer. Clinical & Experimental Metastasis, 35(7), 635-640. doi:10.1007/s10585-018-9925-7

Giorgio, A. D., Sgarbura, O., Rotolo, S., Schena, C. A., Bagalà, C., Inzani, F., . . . Pacelli, F. (2020). Pressurized intraperitoneal aerosol chemotherapy with cisplatin and doxorubicin or oxaliplatin for peritoneal metastasis from pancreatic adenocarcinoma and cholangiocarcinoma. Therapeutic Advances in Medical Oncology, 12, 175883592094088. doi:10.1177/1758835920940887

Demtröder, C., Solass, W., Zieren, J., Strumberg, D., Giger-Pabst, U., & Reymond, M. (2016). Pressurized intraperitoneal aerosol chemotherapy with oxaliplatin in colorectal peritoneal metastasis. Colorectal Disease, 18(4), 364-371. doi:10.1111/codi.13130

Nadiradze, G., Giger-Pabst, U., Zieren, J., Strumberg, D., Solass, W., & Reymond, M. (2015). Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with Low-Dose Cisplatin and Doxorubicin in Gastric Peritoneal Metastasis. Journal of Gastrointestinal Surgery, 20(2), 367-373. doi:10.1007/s11605-015-2995-9

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