Abstract
Background
Inducing oxidative stress under hyperthermic conditions significantly decreases tumor cell growth in a murine model of human colon cancer carcinomatosis. This phase I study examines the safety and pharmacokinetics of induced oxidative stress by the addition of hydrogen peroxide (H2O2) to the perfusate in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced abdominal-only malignancies.
Methods
Patients with advanced colon or appendiceal malignancies underwent maximal cytoreduction followed by HIPEC with mitomycin C (MMC). In addition, H2O2 was added to the perfusate at three concentrations (n = 3/level, 0.05, 0.075, 0.1 %). A control group consisted of patients perfused with MMC alone (n = 3). Perfusate, serum MMC, and H2O2 levels were measured, as were tissue levels of MMC.
Results
Twelve patients were enrolled onto this trial. The median (range) peritoneal carcinomatosis index was 13 (3–20) requiring a median operative time of 6.3 (4–8.5) h. The median postoperative length of stay was 9 (5–34) days, with six patients requiring readmission within 30 days. Similar complications were observed at all three H2O2 levels, as well as in the control group. One patient required reexploration for a colon perforation (control group), and three patients developed enterocutaneous fistulas (0.075 % H2O2, 0.1 % H2O2 and control group). There were no operative mortalities.
Conclusions
Hyperthermic intraperitoneal chemotherapy with induced oxidative stress after maximal cytoreduction is well tolerated. On the basis of the encouraging toxicity profile after cytoreduction and HIPEC with induced oxidative stress, a phase II trial to verify activity is indicated.
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References
Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15:2426–32.
Reichman TW, Cracchiolo B, Sama J, et al. Cytoreductive surgery and intraoperative hyperthermic chemoperfusion for advanced ovarian carcinoma. J Surg Oncol. 2005;90:51–6.
Loggie BW, Fleming RA, McQuellon RP, Russell GB, Geisinger KR. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin. Am Surg. 2000;66:561–8.
Li GC, Mivechi NF, Weitzel G. Heat shock proteins, thermotolerance, and their relevance to clinical hyperthermia. Int J Hyperthermia. 1995;11:459–88.
Chen F, Wang CC, Kim E, Harrison LE. Hyperthermia in combination with oxidative stress induces autophagic cell death in HT-29 colon cancer cells. Cell Biol Int. 2008;32:715–23.
Wang CC, Chen F, Kim E, Harrison LE. Thermal sensitization through ROS modulation: a strategy to improve the efficacy of hyperthermic intraperitoneal chemotherapy. Surgery. 2007;142:384–92.
Razavi R, Harrison LE. Thermal sensitization using induced oxidative stress decreases tumor growth in an in vivo model of hyperthermic intraperitoneal perfusion. Ann Surg Oncol. 2010;17:304–11.
Sugarbaker PH. Management of peritoneal-surface malignancy: the surgeon’s role. Langenbecks Arch Surg. 1999;384:576–87.
Shen P, Hawksworth J, Lovato J, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol. 2004;11:178–86.
Paroni R, Arcelloni C, De Vecchi E, Fermo I, Mauri D, Colombo R. Plasma mitomycin C concentrations determined by HPLC coupled to solid-phase extraction. Clin Chem. 1997;43:615–8.
Paroni R, Salonia A, Lev A, et al. Effect of local hyperthermia of the bladder on mitomycin C pharmacokinetics during intravesical chemotherapy for the treatment of superficial transitional cell carcinoma. Br J Clin Pharmacol. 2001;52:273–8.
Pallepati P, Averill-Bates D. Mild thermotolerance induced at 40 degrees C increases antioxidants and protects HeLa cells against mitochondrial apoptosis induced by hydrogen peroxide: role of p53. Arch Biochem Biophys. 2010;495:97–111.
Calderwood SK, Asea A. Targeting HSP70-induced thermotolerance for design of thermal sensitizers. Int J Hyperthermia. 2002;18:597–608.
Jacquet P, Stephens AD, Averbach AM, et al. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer. 1996;77:2622–9.
Rudin CM, Yang Z, Schumaker LM, et al. Inhibition of glutathione synthesis reverses Bcl-2-mediated cisplatin resistance. Cancer Res. 2003;63:312–8.
Miller RA, Woodburn KW, Fan Q, et al. Motexafin gadolinium: a redox active drug that enhances the efficacy of bleomycin and doxorubicin. Clin Cancer Res. 2001;7:3215–21.
Dovern E, de Hingh IH, Verwaal VJ, van Driel WJ, Nienhuijs SW. Hyperthermic intraperitoneal chemotherapy added to the treatment of ovarian cancer. A review of achieved results and complications. Eur J Gynaecol Oncol. 2010;31:256–61.
Harrison LE, Bryan M, Pliner L, Saunders T. Phase I trial of pegylated liposomal doxorubicin with hyperthermic intraperitoneal chemotherapy in patients undergoing cytoreduction for advanced intra-abdominal malignancy. Ann Surg Oncol. 2008;15:1407–13.
Katschinski DM, Boos K, Schindler SG, Fandrey J. Pivotal role of reactive oxygen species as intracellular mediators of hyperthermia-induced apoptosis. J Biol Chem. 2000;275:21094–8.
Nakamura M, Motoyama S, Saito S, Minamiya Y, Saito R, Ogawa J. Hydrogen peroxide derived from intestine through the mesenteric lymph induces lung edema after surgical stress. Shock. 2004;21:160–4.
Van der Speeten K, Stuart OA, Chang D, Mahteme H, Sugarbaker PH. Changes induced by surgical and clinical factors in the pharmacology of intraperitoneal mitomycin C in 145 patients with peritoneal carcinomatosis. Cancer Chemother Pharmacol. 2011;68:147–56.
Kusamura S, Dominique E, Baratti D, Younan R, Deraco M. Drugs, carrier solutions and temperature in hyperthermic intraperitoneal chemotherapy. J Surg Oncol. 2008;98:247–52.
Schmitt CP, Haraldsson B, Doetschmann R, et al. Effects of pH-neutral, bicarbonate-buffered dialysis fluid on peritoneal transport kinetics in children. Kidney Int. 2002;61:1527–36.
Kennedy KA, McGurl JD, Leondaridis L, Alabaster O. pH dependence of mitomycin C-induced cross-linking activity in EMT6 tumor cells. Cancer Res. 1985;45:3541–7.
Pan SS, Yu F, Hipsher C. Enzymatic and pH modulation of mitomycin C-induced DNA damage in mitomycin C-resistant HCT 116 human colon cancer cells. Mol Pharmacol. 1993;43:870–7.
Yu F, Pan S. Effect on pH on DNA alkylation by enzyme-activated mitomycin C and porfiromycin. Mol Pharmacol. 1993;43:863–69.
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Harrison, L.E., Tiesi, G., Razavi, R. et al. A Phase I Trial of Thermal Sensitization Using Induced Oxidative Stress in the Context of HIPEC. Ann Surg Oncol 20, 1843–1850 (2013). https://doi.org/10.1245/s10434-013-2874-0
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DOI: https://doi.org/10.1245/s10434-013-2874-0