Mayo Clinic offers only U.S. clinical trial of innovative chemotherapy method to make untreatable abdominal cancers treatable.
Mayo Clinic in Florida is participating in the only U.S. clinical trial on the safety and efficacy of PIPAC, an innovative potential solution for people whose cancer has spread or metastasized to their abdominal cavity and is untreatable using conventional approaches. The study’s principal investigator at Mayo Clinic is Amit Merchea, M.D., a board-certified colon and rectal surgeon and Vice Chair of Clinical Practice for the Department of Surgery at Mayo Clinic in Jacksonville, Florida.
What is PIPAC?
PIPAC – short for pressurized intraperitoneal aerosol chemotherapy – delivers chemotherapy in an aerosol form directly to cancer cells in the peritoneum, a membrane that lines the abdominal cavity and organs within it. Mayo Clinic is studying the safety of treatment with PIPAC for people who have primary ovarian, uterine, gastric, colorectal cancer that has spread to their peritoneum.
Treatment starts with selecting the most effective chemotherapy agent for the patient’s specific cancer. The PIPAC procedure involves dispersing the chemotherapy into the patient’s abdominal cavity using minimally invasive laparoscopic techniques and a special nebulizer device that pressurizes the chemotherapy and turns it into an aerosol.
The aerosol circulates in the abdominal cavity for 30 minutes so it can penetrate deeply into the tumor cells. It is then removed using a closed air waste evacuation system. The entire procedure takes about an hour and does not require a hospital stay.
Amit Merchea, MD, and his team performed the first PIPAC procedure in the United States in 2019, at the Mayo Clinic campus in Jacksonville, Fla.
The goals of PIPAC are to:
- Slow or stop the cancer’s progression.
- Shrink tumors so they are small enough to surgically remove. About 10 to 15 percent of people who receive PIPAC are then able to have surgery to remove tumors.
- Reduce hospital stays and side effects. Compared to standard therapy, PIPAC is associated with a higher number of good days, fewer and shorter hospitalizations, and longer overall survival with maintained quality of life.
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Who is PIPAC for?
PIPAC is considered a safe option for people with advanced cancer when there’s no other effective treatment – when conventional surgical, medical, and radiation approaches won’t work. PIPAC is less toxic than conventional chemotherapy, less invasive than open surgery, and carries less risk for complications.
Patient advantages of PIPAC include:
- The ability to directly attack cancer in the peritoneum. Other chemotherapy delivery methods, like IV delivery and HIPEC, are less efficient at targeting peritoneal cancers.
- Less risk of drug side effects. PIPAC uses far lower doses than conventional chemotherapy treatment.
- The ability to provide PIPAC multiple times. This treatment can be provided repeatedly, unlike conventional chemotherapy.
- Less surgical risk. PIPAC is a minimally invasive treatment, which is associated with less risk of side effects and a quicker recovery. It is generally an outpatient procedure.
- Better ability to evaluate the cancer’s response. It’s difficult to evaluate peritoneal tumors’ response to chemotherapy using the traditional imaging methods. With PIPAC, a biopsy is performed at each treatment to accurately evaluate tumor response.
Why is Mayo Clinic focused on PIPAC?
At Mayo Clinic, multidisciplinary teams work together to move medicine forward and drive new solutions. A high-volume center for treating people with peritoneal disease, Mayo Clinic brings together a multidisciplinary team of experts to provide PIPAC.
In Europe, where thousands of patients have been treated with PIPAC, tumor response rates range from 40 to 60%. In the U.S., where Mayo Clinic in Florida has completed about 35 procedures, early data shows an increase in the number of good days at 6 months (181 vs. 131 days) and at 1 year (323 vs. 131). PIPAC patients also had a lower number of inpatient hospitalizations compared to standard therapy. There was also an improved overall survival of 11.3 months vs. 5.1 months in the PIPAC cohort.
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