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Review
. 2021 Apr;12(Suppl 1):S242-S258.
doi: 10.21037/jgo-20-257.

Pressurized intraperitoneal aerosol chemotherapy with oxaliplatin (PIPAC-OX) in patients with colorectal peritoneal metastases-a systematic review

Robin J Lurvink  1 , Koen P Rovers  1 , Simon W Nienhuijs  1 , Geert-Jan Creemers  2 , Jacobus W A Burger  1 , Ignace H J de Hingh  1   3
Affiliations
Review

Pressurized intraperitoneal aerosol chemotherapy with oxaliplatin (PIPAC-OX) in patients with colorectal peritoneal metastases-a systematic review

Robin J Lurvink et al. J Gastrointest Oncol. 2021 Apr.

Abstract

Pressurized intraperitoneal aerosol chemotherapy with oxaliplatin (PIPAC-OX) is increasingly used as a palliative treatment option for patients with colorectal peritoneal metastases (CPM). The present study aimed to systematically review all clinical studies reporting safety and efficacy outcomes of PIPAC-OX in patients with CPM. PubMed, EMBASE, The Cochrane Library, and CINAHL were systematically searched to identify all clinical studies that included at least one patient with CPM treated with PIPAC-OX and reported one of the following outcomes: adverse events, tumor response, quality of life, secondary cytoreductive surgery, progression-free survival, overall survival, and environmental safety of PIPAC-OX. Results were narratively described. Of 28 included studies, only 14 non-comparative studies separately reported at least one outcome of PIPAC-OX for CPM, of which only two studies specifically focused on this group. These 14 studies reported adverse events (5 studies), tumor response (5 studies), secondary cytoreductive surgery (4 studies), progression-free survival (1 study), overall survival (5 studies), and environmental safety (2 studies). Except for 5 studies (describing 26 patients), none of the included studies stratified their results for PIPAC-OX monotherapy and PIPAC-OX with concomitant systemic therapy, and none of the studies reporting survival outcomes stratified results for line of palliative treatment, complicating interpretation. No PIPAC-OX related deaths were reported. No occupational platinum was detected during PIPAC-OX. The available evidence regarding PIPAC-OX for CPM is limited and difficult to interpret. Despite these limitations, PIPAC-OX appears safe in patients with CPM and safe for operating personnel. To increase insight in the role of PIPAC-OX in this setting, investigators of ongoing and future studies are encouraged to report separate outcomes of PIPAC-OX for CPM, to stratify their results for PIPAC-OX monotherapy and PIPAC-OX with concomitant systemic therapy, and to stratify survival results for line of palliative treatment.

Keywords: Pressurized intraperitoneal aerosol chemotherapy (PIPAC); colorectal cancer; oxaliplatin; peritoneal metastases.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo-20-257). The focused issue was sponsored by the Peritoneal Surface Oncology Group International (PSOGI). IHJH reports grants from ROCHE, grants from RanD Biotech, outside the submitted work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Literature search and study selection. CPM, Colorectal peritoneal metastases; PIPAC, pressurized intraperitoneal aerosol chemotherapy. Details of the literature search and study selection are presented in the Appendix.
See this image and copyright information in PMC

Comment in

  • PIPAC may work but more data is needed.
    Sugarbaker PH, Van der Speeten K. Sugarbaker PH, et al. J Gastrointest Oncol. 2021 Apr;12(Suppl 1):S271-S272. doi: 10.21037/jgo-2020-22. J Gastrointest Oncol. 2021. PMID: 33970164 Free PMC article. No abstract available.

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