Dr. Andikyan on the Rationale of Using HIPEC in Ovarian Cancer

Vaagn Andikyan, MD, assistant professor of Obstetrics, Gynecology and Reproductive Sciences, Yale Medicine, Yale Cancer Center, discusses the utilization of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with stage III epithelial ovarian cancer.

In a phase 3 trial (NCT00426257; EudraCT number, 2006-003466-34), investigators randomly assigned patients with stage III epithelial ovarian cancer to receive secondary debulking with or without the addition of HIPEC. The chemotherapy regimen was administered at the time of interval debulking surgeries, Andikyan explains.

The goal HIPEC is to facilitate the delivery of treatment as close to the tumor as possible; the addition of heat adds a cumulative effect to the efficacy of chemotherapy, Andikyan notes.

In the large, randomized, prospective study conducted in Europe, the addition of HIPEC demonstrated superiority compared with conventional debulking surgery alone. This study evaluated patients with stage III ovarian cancer who had at least stable disease following 3 cycles of neoadjuvant chemotherapy, and they then received interval debulking surgery with or without HIPEC.

Patients in the HIPEC arm experienced a median recurrence-free survival of 14.2 months, compared with 10.7 months for those who received surgery alone. Additionally, at a median follow-up of 4.7 years, 50% of patients in the HIPEC group had died, compared with 62% in the surgery alone group (HR, 0.67; 95% CI, 0.48-0.94; P= .02). The median overall survival was 45.7 months and 33.9 months for the HIPEC and surgery alone groups, respectively.

These positive data led to the widespread acceptance of this treatment modality in many institutions, Andikyan emphasizes, as clinicians began incorporating HIPEC into the surgical armamentarium for patients with ovarian cancer.

The ongoing phase 3 CHIPPI-1808 trial (NCT03842982) is evaluating HIPEC with either primary debulking surgery or interval debulking surgery in patients with ovarian cancer, aiming to assess disease-free survival for the use of HIPEC combined with standard debulking with or without HIPEC, Andikyan concludes.