Skip to main content

Advertisement

SpringerLink
Log in

Peritoneal metastasis from pancreatic cancer treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC)

  • Research Paper
  • Published:
Clinical & Experimental Metastasis Aims and scope Submit manuscript

Abstract

Patients with peritoneal metastasis (PM) from pancreatic cancer have a short life expectancy. Systemic combination chemotherapy leads to a median overall survival of 7–8 months. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a treatment alternative, where studies in patients with PM from ovarian, gastric and colorectal cancer show a high safety profile and interesting results. This case study report data on the PIPAC treatment in patients with PM from pancreatic cancer. In a standard laparoscopy, chemotherapeutics (cisplatin and doxorubicin) are nebulized within the peritoneal cavity. After 30 min, the chemotherapeutics are evacuated through a closed system. The PIPAC procedure is repeated every 4–6 weeks. Five patients with PM from pancreatic cancer were treated with a total of 16 PIPAC procedures. All patients received >1 PIPAC and were eligible for evaluation of histological regression. Four patients demonstrated histological regression, and one patient had stable disease. Three patients are still alive, and the median overall survival is 14 months (range 10–20) since the diagnosis of PM. The histological regression and survival figures in this pilot study suggest activity of PIPAC with low-dose cisplatin and doxorubicin in pretreated peritoneal metastasis of pancreatic origin. This should now be evaluated in prospective studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49:1374–1403

    Article  CAS  PubMed  Google Scholar 

  2. Bjerregaard JK, Mortensen MB, Pfeiffer P (2016) Trends in cancer of the liver, gall bladder, bile duct, and pancreas in elderly in Denmark, 1980–2012. Acta Oncol 55(Suppl 1):40–45

    Article  PubMed  Google Scholar 

  3. Coupland VH, Konfortion J, Jack RH et al (2016) Resection rate, hospital procedure volume and survival in pancreatic cancer patients in England: population-based study, 2005–2009. Eur J Surg Oncol 42:190–196

    Article  CAS  PubMed  Google Scholar 

  4. Stark AP, Sacks GD, Rochefort MM et al (2016) Long-term survival in patients with pancreatic ductal adenocarcinoma. Surgery 159:1520–1527

    Article  PubMed  PubMed Central  Google Scholar 

  5. House MG, Gonen M, Jarnagin WR et al (2007) Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg 11:1549–1555

    Article  PubMed  Google Scholar 

  6. Sohn TA, Yeo CJ, Cameron JL et al (2000) Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4:567–579

    Article  CAS  PubMed  Google Scholar 

  7. Lim JE, Chien MW, Earle CC (2003) Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 237:74–85

    Article  PubMed  PubMed Central  Google Scholar 

  8. Richter A, Niedergethmann M, Sturm JW et al (2003) Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg 27:324–329

    Article  PubMed  Google Scholar 

  9. Gillen S, Schuster T, Meyer Zum Buschenfelde C et al (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7:e1000267

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sudo K, Ishihara T, Hirata N et al (2014) Randomized controlled study of gemcitabine plus S-1 combination chemotherapy versus gemcitabine for unresectable pancreatic cancer. Cancer Chemother Pharmacol 73:389–396

    Article  CAS  PubMed  Google Scholar 

  11. Tabernero J, Chiorean EG, Infante JR et al (2015) Prognostic factors of survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer. Oncologist 20:143–150

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bjerregaard JK, Mortensen MB, Schonnemann KR, Pfeiffer P (2013) Characteristics, therapy and outcome in an unselected and prospectively registered cohort of pancreatic cancer patients. Eur J Cancer 49:98–105

    Article  CAS  PubMed  Google Scholar 

  13. Sadeghi B, Arvieux C, Glehen O et al (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363

    Article  CAS  PubMed  Google Scholar 

  14. Thomassen I, Lemmens VE, Nienhuijs SW et al (2013) Incidence, prognosis, and possible treatment strategies of peritoneal carcinomatosis of pancreatic origin: a population-based study. Pancreas 42:72–75

    Article  PubMed  Google Scholar 

  15. Sugarbaker PH (1998) Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 14:254–261

    Article  CAS  PubMed  Google Scholar 

  16. Solass W, Kerb R, Murdter T et al (2014) Intraperitoneal chemotherapy of peritoneal carcinomatosis using pressurized aerosol as an alternative to liquid solution: first evidence for efficacy. Ann Surg Oncol 21:553–559

    Article  PubMed  Google Scholar 

  17. Solass W, Giger-Pabst U, Zieren J, Reymond MA (2013) Pressurized intraperitoneal aerosol chemotherapy (PIPAC): occupational health and safety aspects. Ann Surg Oncol 20:3504–3511

    Article  PubMed  PubMed Central  Google Scholar 

  18. Graversen M, Pedersen PB, Mortensen MB (2016) Environmental safety during the administration of pressurized intraperitoneal aerosol chemotherapy. Pleura and Peritoneum 1(4):203–208

    Article  Google Scholar 

  19. Blanco A, Giger-Pabst U, Solass W et al (2013) Renal and hepatic toxicities after pressurized intraperitoneal aerosol chemotherapy (PIPAC). Ann Surg Oncol 20:2311–2316

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tempfer CB, Celik I, Solass W et al (2014) Activity of pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin in women with recurrent, platinum-resistant ovarian cancer: preliminary clinical experience. Gynecol Oncol 132:307–311

    Article  CAS  PubMed  Google Scholar 

  21. Tempfer CB, Winnekendonk G, Solass W et al (2015) Pressurized intraperitoneal aerosol chemotherapy in women with recurrent ovarian cancer: a phase 2 study. Gynecol Oncol 137:223–228

    Article  CAS  PubMed  Google Scholar 

  22. Nadiradze G, Giger-Pabst U, Zieren J et al (2016) Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with low-dose cisplatin and doxorubicin in gastric peritoneal metastasis. J Gastrointest Surg 20:367–373

    Article  PubMed  Google Scholar 

  23. Demtroder C, Solass W, Zieren J et al (2016) Pressurized intraperitoneal aerosol chemotherapy with oxaliplatin in colorectal peritoneal metastasis. Colorectal Dis 18:364–371

    Article  CAS  PubMed  Google Scholar 

  24. Solass W, Hetzel A, Nadiradze G et al (2012) Description of a novel approach for intraperitoneal drug delivery and the related device. Surg Endosc 26:1849–1855

    Article  PubMed  Google Scholar 

  25. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  26. Solass W, Detlefsen S, Carr N et al (2016) Peritoneal sampling and histological assessment of therapeutic response in peritoneal metastasis: proposal of the Peritoneal Regression Grading Score (PRGS). Pleura and Peritoneum 1(2):99–107

    Article  Google Scholar 

  27. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247

    Article  CAS  PubMed  Google Scholar 

  28. Takahara N, Isayama H, Nakai Y et al (2016) Intravenous and intraperitoneal paclitaxel with S-1 for treatment of refractory pancreatic cancer with malignant ascites. Invest New Drugs 34:636–642

    Article  CAS  PubMed  Google Scholar 

  29. Oman M, Blind PJ, Naredi P et al (2001) Treatment of non-resectable pancreatic cancer with intraperitoneal 5-FU and leucovorin IV. Eur J Surg Oncol 27:477–481

    Article  CAS  PubMed  Google Scholar 

  30. Flessner MF (2005) The transport barrier in intraperitoneal therapy. Am J Physiol Renal Physiol 288:F433–F442

    Article  CAS  PubMed  Google Scholar 

  31. Jacquet P, Stuart OA, Chang D, Sugarbaker PH (1996) Effects of intra-abdominal pressure on pharmacokinetics and tissue distribution of doxorubicin after intraperitoneal administration. Anticancer Drugs 7:596–603

    Article  CAS  PubMed  Google Scholar 

  32. Solass W, Herbette A, Schwarz T et al (2012) Therapeutic approach of human peritoneal carcinomatosis with Dbait in combination with capnoperitoneum: proof of concept. Surg Endosc 26:847–852

    Article  PubMed  Google Scholar 

  33. Reymond MA (2014) PIPAC pressurized intraperitoneal aerosol chemotherapy—Cancer under pressure. Walter de Gruyter, Berlin

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Upper GI and HPB Section, Department of Surgery, Odense Patient Explorative Network (OPEN), Odense University Hospital, J.B. Winsloews Vej 4, 5000, Odense, Denmark

    Martin Graversen & Michael Bau Mortensen

  2. Department of Pathology, Odense University Hospital, Odense, Denmark

    Sönke Detlefsen

  3. Department of Oncology, Odense University Hospital, Odense, Denmark

    Jon Kroll Bjerregaard & Per Pfeiffer

Authors
  1. Martin Graversen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sönke Detlefsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jon Kroll Bjerregaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Per Pfeiffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Bau Mortensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Graversen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study complies with the Helsinki Declaration and was approved by The Regional Committees on Health Research Ethics for Southern Denmark (Project-ID: S-20140211, http://www.clinicaltrials.gov NCT02320448), and all participants gave oral and written informed consent.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Graversen, M., Detlefsen, S., Bjerregaard, J.K. et al. Peritoneal metastasis from pancreatic cancer treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC). Clin Exp Metastasis 34, 309–314 (2017). https://doi.org/10.1007/s10585-017-9849-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10585-017-9849-7

Keywords

Search

Navigation