PIPAC + IV chemotherapy

PIPAC + IV chemotherapy is a bidirectional treatment approach that combines Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with intravenous (IV) chemotherapy for treating peritoneal carcinomatosis, particularly in patients with abdominal cancers. ## What is PIPAC? PIPAC is a minimally invasive procedure that delivers chemotherapy directly into the peritoneal cavity as a pressurized aerosol. The procedure involves: 1. Creating a laparoscopic access to the abdominal cavity using small incisions 2. Insufflating the abdomen with carbon dioxide to a pressure of about 12 mm Hg 3. Introducing a specialized nebulizer that converts liquid chemotherapy into an aerosol 4. Spraying the aerosolized chemotherapy under pressure throughout the abdominal cavity 5. Maintaining the system in a steady state for about 30 minutes[2][6] The physical principles behind PIPAC's effectiveness include: - More homogeneous drug distribution through aerosolization compared to liquid solutions - Enhanced drug penetration into tumor tissue due to the pressure gradient - Counteracting of interstitial fluid pressure within tumors that typically impairs drug uptake - Ability to monitor and adjust environmental parameters for optimal efficacy[6] ## Bidirectional Approach (PIPAC + IV Chemotherapy) When PIPAC is combined with systemic IV chemotherapy, it's referred to as a "bidirectional" approach[6]. This combination offers several advantages: - Intravenously applied chemotherapy may improve subperitoneal drug accumulation - Systemic chemotherapy can target circulating tumor cells and micrometastases - The combination addresses both local and systemic disease[6] Studies have shown that this bidirectional approach is safe and feasible, with pathologic response achieved in approximately 60% of patients and 1-year overall survival rates exceeding 50% in gastric cancer patients with peritoneal metastases[6]. ## Clinical Applications PIPAC + IV chemotherapy is primarily used for: - Peritoneal carcinomatosis from various primary cancers - Patients who may not be candidates for complete cytoreductive surgery - Cases where traditional treatments have limited effectiveness - Converting initially inoperable cases to operable ones[5][7] The specific IV chemotherapy regimen used in combination with PIPAC may vary depending on the primary cancer type. For example, FOLFOX (a combination of folinic acid, fluorouracil, and oxaliplatin) is being investigated in combination with PIPAC for gastric cancer with peritoneal metastases[6]. ## Advantages Over Other Treatments Compared to other intraperitoneal chemotherapy approaches like HIPEC (Hyperthermic Intraperitoneal Chemotherapy), PIPAC + IV chemotherapy offers: - Less invasive procedure with smaller incisions - Reduced systemic side effects - Ability to be repeated multiple times - Opportunity for tumor biopsies during each procedure to monitor response - Potential for use in patients with more advanced disease[5][7] While HIPEC is typically used with curative intent following cytoreductive surgery, PIPAC is often used with palliative intent, though its indications are evolving as research progresses[7].

Other names

Bidirectional therapy (PIPAC and IV chemotherapy)