HIPEC following surgery shows no survival advantage in ovarian cancer

South Korea: In patients with advanced epithelial ovarian cancer, adding hyperthermic intraperitoneal chemotherapy (HIPEC) following cytoreductive surgery did not increase progression-free or overall survival, says an article published in the Journal of American Medical Association - Surgery.

"The results although are from a subgroup analysis, HIPEC addition to interval cytoreductive surgery provided an improvement of progression-free and overall survival," the researchers wrote in their study.

Among gynecologic malignant tumors, ovarian cancer has the greatest fatality rate. There is a dearth of data on the survival benefit of HIPEC in ovarian cancer patients who underwent main or interval cytoreductive surgery. As a result, Myong Cheol Lim and colleagues undertook this trial to evaluate the therapeutic value of HIPEC following primary or interval maximum cytoreductive surgery in women having stage III or IV primary advanced ovarian cancer.

From March 2, 2010, to January 22, 2016, 184 patients with stage III or IV ovarian cancer with residual tumor size less than 1 cm were randomized (1:1) to a HIPEC (41.5 °C, 75 mg/m2 cisplatin, 90 minutes) or control group in this single-blind randomized clinical trial at two South Korean institutions. The major goal was to achieve progression-free survival. The primary-secondary end objectives were overall survival and adverse events. The most recent follow-up occurred on January 10, 2020, and the data were locked on February 17, 2020. The research included participants who were getting HIPEC following cytoreductive surgery.

The key findings of this study are as follow:

1. Among the 184 Korean women who were randomly assigned, 92 were assigned to the HIPEC group and 92 to the control group.

2. After 69.4 months of follow-up, the median progression-free survival in the control group was 18.8 months and 19.8 months in the HIPEC group (P =.43), and the median overall survival was 61.3 months in the control group and 69.5 months in the HIPEC group (P =.52).

3. The median progression-free survival in the interval cytoreductive surgery group following neoadjuvant chemotherapy was 15.4 months in the control group and 17.4 months in the HIPEC group, while the median overall survival was 61.8 months in the HIPEC group and 48.2 months in the control group.

4. The median progression-free survival in the subgroup with initial cytoreductive surgery was 29.7 months in the control group and 23.9 months in the HIPEC group, while the median overall survival was not attained in the control group and 71.3 months in the HIPEC group.

In conclusion, the survival advantage of HIPEC immediately following primary cytoreductive surgery was not discovered in this analysis and should be studied further in future clinical studies.

Reference:

Lim MC, Chang S, Park B, et al. Survival After Hyperthermic Intraperitoneal Chemotherapy and Primary or Interval Cytoreductive Surgery in Ovarian Cancer: A Randomized Clinical Trial. JAMA Surg. Published online March 09, 2022. doi:10.1001/jamasurg.2022.0143

Keywords: HIPEC, chemotherapy, ovarian cancer, cytoreductive surgery, cisplatin, malignant tumor, JAMA, surgery