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. 2022 Mar 1;7(1):1-7.
doi: 10.1515/pp-2022-0102.

Consensus statement for treatment protocols in pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Olivia Sgarbura  1   2 , Clarisse Eveno  3 , Mohammad Alyami  4 , Naoual Bakrin  5   6 , Delia Cortes Guiral  4 , Wim Ceelen  7 , Xavier Delgadillo  8 , Thanh Dellinger  9 , Andrea Di Giorgio  10 , Amaniel Kefleyesus  5   11 , Vladimir Khomiakov  12 , Michael Bau Mortensen  13 , Jamie Murphy  14 , Marc Pocard  15   16 , Marc Reymond  17 , Manuela Robella  18 , Koen P Rovers  19 , Jimmy So  20 , S P Somashekhar  21 , Clemens Tempfer  22 , Kurt Van der Speeten  23 , Laurent Villeneuve  6   24 , Wei Peng Yong  25 , Martin Hübner  11
Affiliations

Consensus statement for treatment protocols in pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Olivia Sgarbura et al. Pleura Peritoneum. .

Abstract

Objectives: Safe implementation and thorough evaluation of new treatments require prospective data monitoring and standardization of treatments. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising alternative for the treatment of patients with peritoneal disease with an increasing number of suggested drug regimens. The aim was to reach expert consensus on current PIPAC treatment protocols and to define the most important research topics.

Methods: The expert panel included the most active PIPAC centers, organizers of PIPAC courses and principal investigators of prospective studies on PIPAC. A comprehensive literature review served as base for a two-day hybrid consensus meeting which was accompanied by a modified three-round Delphi process. Consensus bar was set at 70% for combined (strong and weak) positive or negative votes according to GRADE. Research questions were prioritized from 0 to 10 (highest importance).

Results: Twenty-two out of 26 invited experts completed the entire consensus process. Consensus was reached for 10/10 final questions. The combination of doxorubicin (2.1 mg/m2) and cisplatin (10.5 mg/m2) was endorsed by 20/22 experts (90.9%). 16/22 (72.7%) supported oxaliplatin at 120 with potential reduction to 90 mg/m2 (frail patients), and 77.2% suggested PIPAC-Ox in combination with 5-FU. Mitomycin-C and Nab-paclitaxel were favoured as alternative regimens. The most important research questions concerned PIPAC conditions (n=3), standard (n=4) and alternative regimens (n=5) and efficacy of PIPAC treatment (n=2); 8/14 were given a priority of ≥8/10.

Conclusions: The current consensus should help to limit heterogeneity of treatment protocols but underlines the utmost importance of further research.

Keywords: PIPAC; cisplatin; doxorubicin; oxaliplatin; peritoneal metastasis; standardisation; treatment protocol.

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Conflict of interest statement

Competing interests: The following disclosure were made: MH: 1. Research funding (institution): Nestlé health science. 2. Speaker honorary (institution): MSD, Nestlé, Fresenius, Capnomed, Encare. 3. Boards: ERAS society: chair education, ISSPP: chair education. MR: 1.Research funding: Capnomed GmbH, Fisher Paykel, Alesi Surgical. 2. Speaker honorary: Boerhinger Ingelheim. 3. Stock shareholder: Capnomed GmbH. MP: Research funding: Capnomed GmbH, IDmed, INSERM laboratory unit. XD: Speaker honorary: Capnomed GmbH, Consultant for Latin America. WPY: Speaker honorary: Astra Zeneca, BMS, Eli Lilly, Novartis. The rest of the authors have no competing interests.

Figures

Figure 1:
Figure 1:
Expert consensus on PIPAC regimens.
Figure 2:
Figure 2:
Research priorities to optimize PIPAC treatment. The most important research questions were identified and discussed during the consensus meeting. Panelists rated importance of the topics on a scale from 0 to 10 (highest importance).
See this image and copyright information in PMC

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