Over 200 participants registered to ISSPP’s webinar with the title “Neoadjuvant and adjuvant PIPAC” on May 29th, 2021. The webinar was chaired by Vladimir Khomyakov from P.A. Hertsen Moscow Research Oncological Institute (Moscow, Russia) and Prof. Beate Rau from Charité Medical University (Berlin, Germany). Six speakers presented the last advances in using PIPAC as a part of (neo-)adjuvant treatment in gastric cancer (GC) and the data from ongoing clinical trials on the combination of surgery and PIPAC.
Results of the most extensive phase-2 study on PIPAC in GC (over 500 PIPAC procedures), presented by Vladimir Khomyakov, show that PIPAC combined with systemic chemotherapy could be used as neoadjuvant treatment followed by “conversion surgery” in patients with GC and limited peritoneal metastasis. Khomyakov recommends surgery after six months of systemic chemotherapy and at least two PIPAC sessions. Simultaneous gastrectomy and (normothermic) PIPAC with low doses cisplatin and doxorubicin were better tolerated than (high-dose and hyperthermic) HIPEC. Prof. Michael Mortensen (Denmark) also reported the safety of simultaneous gastrectomy (open or laparoscopic) and PIPAC in the PIPAC-OPC4 trial (NCT04047004). Martin Graversen (Denmark) presented results from the PIPAC-OPC3 trial (NCT03280511) and concluded that prophylactic PIPAC with oxaliplatin is feasible at lower doses, promising efficacy on peritoneal recurrence of high-risk colorectal cancer. Stanislav Bykasov (Russia) also reported the safety of PIPAC combined with non-optimal cytoreduction in pseudomyxoma peritonei in a pilot study. The PIPAC-PLUS multicentric retrospective study, presented by Manuella Robella (Italy), demonstrated that PIPAC with (limited) simultaneous surgery is associated with an increase in the duration of operation, length of stay, and medical complications rate but no difference in terms of surgical complications, reoperation rate, and deaths.
Together, the presentations suggest that the addition of PIPAC to gastrectomy (and limited cytoreductive surgery) is feasible and safe. The efficacy of adjuvant PIPAC in locally advanced GC is currently the object of the multicentric randomized GASPACCO Phase-3 trial (NCT04595929) presented by Danila Zaytsev (Russia). This trial is open for the inclusion of additional study centers.
Video recording of the presentations will be soon available for ISSPP members on this website.