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: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) continues to be a more accepted and performed procedure. Patients are commonly exposed to Oxaliplatin neoadjuvant chemotherapy (NAT) regimens prior to surgery. The impact of systemic exposure to Oxaliplatin prior to HIPEC with Oxaliplatin is unknown.
Methods: Retrospective review of our institutional registry of CRS-HIPEC cases that received Oxaliplatin containing NAT. Analysis compared patients who underwent HIPEC with Oxaliplatin versus cases perfused with Mitomycin C. Primary outcome was survival defined by overall survival (OS) and disease-free survival (DFS) with Kaplan-Meier survival curves calculated. Subgroup analysis performed based on primary tumor etiology and completeness of cytoreduction.
Results: A total of 333 cases satisfied selection criteria, 159 appendiceal primaries (all high-grade disease) and 174 colorectal cases. 31 cases (9.3%) underwent HIPEC with Oxaliplatin with the remaining 302 cases (90.7%) receiving Mitomycin C. Both cohorts were identical in regard to baseline demographics, comorbidities, functional status, oncologic characteristics, and surgical outcomes. Furthermore, both groups were alike in regard to NAT regimens and Oxaliplatin exposure (FOLFOX based regimen used in ~82% of cases). There was no difference in survival outcomes. The mean OS times were 2.9 (+/-2.8) vs 2.8 (+/-3.6) years for Oxaliplatin and Mitomycin C perfusions respectively (P=0.942). 5-year OS rates were also similar at 9.7% vs 18.5% (OR=0.488, 95%CI 0.143-1.671, P=0.244) for Oxaliplatin and Mitomycin cases. There was a correlate trend with DFS with mean survival of 2.5 (+/-4.5) vs 1.8 (+/-2.4) years for Oxaliplatin and Mitomycin perfusions respectively (P=0.206). Also no difference in 5-year DFS rates at 10.5% vs 7.8% (OR=1.390, 95%CI 0.295-6.557, P=0.676). Survival curves corresponded (Figure 1). Subgroup analysis found no discordant findings from main results.
Conclusions: This analysis found no discernable effect of NAT Oxaliplatin exposure in regard to survival outcomes following CRS-HIPEC stratified out by perfusion agent.
Learning Objectives:
appreciate that a significant portion of patients who undergo CRS-HIPEC are exposed to neoadjuvant Oxaliplatin therapy.
appreciate that exposure to neaodjuvant Oxaliplatin does not have any impact on survival following CRS-HIPEC as stratified by perfusion agents.
demonstrate that there is no discernible clinical effect of previous systemic Oxaliplatin exposure prior to CRS-HIPEC.
