Surgical Oncologist Tripler Army Medical Center, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Participants should be aware of the following financial/non-financial relationships:
Christopher W. Mangieri, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Introduction: A common practice is to switch chemotherapy perfusion agents for repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). However, there is a paucity of any objective benefit with that practice.
Methods: Retrospective review of our institutional registry with analysis of repeat CRS-HIPEC cases. Compared cases that underwent a perfusion agent switch versus those cases with no switch. Primary outcome was survival analysis as measured by overall survival (OS) and disease-free survival (DFS). Kaplan-Meier survival curves calculated. Subgroup analysis performed based on primary etiology.
Results: 101 cases of repeat CRS-HIPEC were identified. Mitomycin C was used as the index perfusion agent in 84% of cases while Oxaliplatin was utilized in the remaining 16% of cases. 66 cases underwent a perfusion switch with 35 cases using the same agent. Analysis of the entire study population revealed no survival benefit with HIPEC perfusion switch. For OS there were similar mean survival times of 5.15 years (+/-4.1) and 5.14 (+/-3.6) for cases with perfusion switch and no perfusion switch respectively (P=0.985). 5-year OS rates were also similar at 61.4% and 53.3% for switch and non-switch cases (OR 0.409, 95%CI 0.543-3.556, P=0.492). For DFS again no significant difference was found with perfusion switch. Mean DFS was 3.96 years (+/-4.2) and 3.60 years (+/-3.8) for switch and non-switch cases respectively (P=0.744). 5-year DFS rates had more of separation but were statistically insignificant with rates of 52.8% vs 27.8% for switch and non-switch cases (OR 2.906, 95%CI 0.857-9.857, P=0.081). Subgroup analysis had a similar trend to the main results except for a significant difference with DFS for colorectal cases favoring no perfusion switch (mean DFS of 2.15 vs 0.79 years, P=0.036). Kaplan-Meier survival curves had correlating trends (Figure 1).
Conclusions: Study findings revealed no survival benefit with switching chemotherapy perfusion agents for repeat CRS-HIPEC. Analysis is not definitive for lack of utility with perfusion switch but suggests the practice is ineffective.
Learning Objectives:
appreciate that switching HIPEC perfusion agents is a common practice with repeat CRS-HIPEC.
Demonstrate there is no survival benefit with switching HIPEC perfusion agents for repeat CRS-HIPEC.
Appreciate that the routine practice of switching HIPEC perfusion agents with repeat CRS-HIPEC likely has no utility.