PIPAC Therapy

PIPAC, which stands for Pressurized Intraperitoneal Aerosol Chemotherapy, is a cutting-edge approach in the treatment of mesothelioma. This method involves administering chemotherapy in a pressurized aerosol form, directly targeting the tumor tissues in the abdomen, potentially enhancing its effectiveness compared to traditional chemotherapy.

Currently in the phase of clinical evaluation, PIPAC is being explored for its potential in treating patients with peritoneal mesothelioma. Its role is particularly significant in potentially transforming patients initially deemed unsuitable for cytoreductive surgery (CRS) into viable candidates.

PIPAC in Mesothelioma Management

In PIPAC, chemotherapy drugs are delivered directly into the peritoneal cavity, targeting mesothelioma cells more effectively through a pressurized aerosol. This method allows for a more concentrated application of chemotherapy, aiming for deeper penetration into tumor tissues. According to the National Library of Medicine, MESOTIP is a randomized study designed to assess the effectiveness of combining PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) with systemic chemotherapy, compared to systemic chemotherapy alone, as the first-line treatment for Malignant Peritoneal Mesothelioma. Participants in the experimental group will undergo 4 cycles of PIPAC, using Cisplatin and Doxorubicin, alternated with 6 cycles of standard intravenous chemotherapy, consisting of Cisplatin and Pemetrexed.

The primary goal of MESOTIP is to demonstrate an enhancement in overall survival rates among patients receiving the combined treatment approach.

PIPAC versus HIPEC in Mesothelioma Treatment

PIPAC and HIPEC (Heated Intraperitoneal Chemotherapy) are both innovative approaches to delivering chemotherapy for peritoneal mesothelioma. HIPEC involves the administration of heated chemotherapy in conjunction with surgery, while PIPAC uses a pressurized aerosol technique. Surgery combined with HIPEC has been recognized for extending the life expectancy of peritoneal mesothelioma patients.

Post-Procedure Expectations: PIPAC versus HIPEC

Recovery times differ between these two procedures. Patients undergoing HIPEC typically have a hospital stay of 10 to 12 days, while PIPAC patients may be discharged on the same day, given its minimally invasive nature.

Role of PIPAC in Enabling CRS and HIPEC

PIPAC can be used to reduce tumor size in patients where immediate surgery is not viable, potentially making them eligible for CRS followed by HIPEC.

The PIPAC Procedure

The PIPAC procedure typically involves these key steps:

1. Preparation: Creation of access ports in the abdomen.
2. Administration: Introduction of aerosolized chemotherapy into the peritoneum.
3. Port Removal: Removal of devices and closure of incisions.
4. Recovery: Post-procedure monitoring and recovery.

Prospective Benefits of PIPAC for Mesothelioma

Potential advantages of PIPAC include:

• Increased Chemotherapy Concentration: Enhanced drug concentration at the tumor site.
• Alleviation of Symptoms: Early studies suggest PIPAC may reduce mesothelioma symptoms and manage peritoneal effusion.
• Reduced Toxicity: Lower likelihood of significant damage to liver or kidneys.

Ongoing Research and Future Prospects

Research into PIPAC’s effectiveness in mesothelioma treatment is ongoing. Clinical trials are examining its potential as a primary treatment option, contributing to a better understanding of its place in mesothelioma care.

Determining Eligibility for PIPAC

Eligibility for PIPAC is subject to individual clinical trials and patient-specific factors. It may be particularly suitable for patients who are not candidates for more intensive treatments.