Novel Chemotherapy Treatment Advances Survivorship by Outsmarting Gynecologic Cancer
Learn how UH Seidman Cancer Center is one of the first in the country to launch a dedicated program using HIPEC, heated chemotherapy, to treat certain types of gynecological cancers.
Robert DeBernardo, MD, a gynecologic oncologist with University Hospitals Case Medical Center and Assistant Professor at Case Western Reserve University School of Medicine, is currently treating gynecologic cancer patients using Hyperthermic Intraperitoneal Chemotherapy (HIPEC). HIPEC involves delivering chemotherapy in a novel way, and when used in combination with surgery, is becoming a promising treatment for gynecologic cancers. HIPEC has been used for several years in patients with other cancers, but Dr. DeBernardo views it as the next step in advancing treatment of gynecologic cancers, including recurrent and new ovarian and certain high risk endometrial cancers.
Combination of HIPEC and Surgery Used to Treat Abdominal and Gynecologic Cancers
HIPEC is a type of hyperthermia therapy used in combination with surgery in the treatment of advanced abdominal cancers. HIPEC has been used for years in patients with colon, pseudomyxomas and appendiceal cancers as well as mesothelioma, cancers that in general are not responsive to chemotherapy. It is now being viewed as a promising new treatment for advanced abdominal and gynecologic cancers, which are generally responsive to chemotherapy, including new and recurrent ovarian cancer and certain high-risk endometrial cancers.
HIPEC is delivered in the operating room immediately after cancer surgery to attack any remaining malignant cells and to delay or abate cancer growth. After a surgeon removes as much of the visible cancer as possible, a chemotherapy agent – heated to 42 to 44 degrees centigrade – is circulated via a perfusion system throughout the abdominal cavity for up to 90 minutes. During this time, the agent penetrates diseased tissue and attacks the remaining cancer cells. After the chemotherapeutic agent is removed, the area is flushed with a sterile saline solution.
It can be either curative or palliative, depending on the type of tumor and how much of the tumor can be removed surgically. In cases where the tumor is completely removed, HIPEC also can be used as adjuvant therapy to potentially prevent recurrence.
Advantages Over Traditional IV Therapy
There are many advantages of using HIPEC in place of traditional intravenous (IV) therapy including:
- Improved survival rates for women with gynecologic cancer
- Targets hard-to-reach surfaces in the peritoneum
- Allows for a much higher dose of chemotherapy to permeate the cancerous tissue than IV chemotherapy which circulates throughout the body and is diluted by the time it reaches the abdomen
- Delivers the chemotherapeutic agent only where it’s needed – sparing healthy tissue and the rest of the body’s exposure to treatment – to help reduce side effects such as hair loss
- Heating a chemotherapeutic agent enhances its effectiveness, increasing cancer cell responsiveness.
- One-time treatment delivered at the time of surgery
Data Shows Positive Outcomes for Patients Treated With HIPEC
HIPEC is showing promising outcomes for gynecologic cancer patients, though giving chemotherapy into the abdomen for women with ovarian cancer is not new. Unfortunately, this type of therapy is complicated because it is delivered over multiple outpatient treatments and, as a result, most women with ovarian cancer are not offered this therapy.
“This is where HIPEC fits in”, Dr. DeBernardo said. “At the time of surgery, patients can be given a heated chemo bath, eliminating multiple outpatient IP treatments as well as the complications associated with it.”
National data on the use of intraperitoneal chemotherapy (IP) to treat ovarian cancer is promising, showing that women with advanced ovarian cancer live an average of 1.5 years longer than women receiving traditional intravenous chemotherapy.
“That’s dramatic,” Dr. DeBernardo said. “The results are clear and definitive. Multiple studies have consistently shown that treatment in the body cavity works.”
One study of patients with gastric cancer and peritoneal metastasis found that those who underwent surgery alone had a median survival rate of eight months. Of the patients who had surgery and HIPEC, 54 percent had a one-year survival rate; 42 percent a three-year survival rate; and 31 percent a five-year survival rate.
“This is a new and potentially revolutionary way of treating women with gynecologic cancers, which tend to be quite responsive to chemotherapy,” Dr. DeBernardo said. “Our preliminary data and experience has been overwhelmingly positive and the therapy has been well-tolerated and effective. HIPEC promises to extend lives in a meaningful way.”
Multidisciplinary Team Leads Efforts in Novel Chemotherapy Treatment
Dr. DeBernardo has developed a dedicated program for HIPEC that incorporates a multi-disciplinary team of surgical oncologists, medical oncologists, intensivists, perfusionists and chemotherapy nurses. Dr. DeBernardo’s team has performed at least 20 procedures since August 2011, averaging one per week. In addition to gynecologic cancers, the HIPEC team is offering the procedure to patients with gastrointestinal cancers and mesothelioma.
UH Case Medical Center plans to launch several Phase One clinical trials this year. These studies will look at morbidity, feasibility, patient tolerance to treatment and outcomes:
- A first-of-its kind study that will use the heated chemotherapy for ovarian cancer that has spread to the thoracic cavity. These hard-to-treat cancers typically recur and Hyperthermic Intrathoracic Chemotherapy (HITEC) is performed after minimally invasive lung surgery by circulating the heated chemotherapy through the thoracic cavity.
- A second study involves ovarian cancer patients in remission who have completed the initial therapy of surgery and chemotherapy. These patients will undergo HIPEC to prevent recurrence. Dr. DeBernardo called this “consolidation” treatment, which is a limited, one-time treatment to extend a patient’s life with one dose of intraperitoneal chemoperfusion.
- A third study will include patients whose cancer recurs, with HIPEC performed following surgical resection of the disease. This treatment will focus on candidates who have oligometastatic disease that is not widespread. What makes ovarian cancer different from other cancers is that it is sensitive to chemotherapy, so patients are expected to benefit from a single dose.
- A fourth study focuses on HIPEC as neoadjuvant chemotherapy, or performing HIPEC in the operating room immediately after surgery. This treatment will focus on patients who have already undergone several intravenous chemotherapy treatments. After the HIPEC procedure, the patient returns to her oncologist for additional treatment.
“We believe this procedure can improve the odds for our patients and we are eager to launch this series of clinical trials to further validate HIPEC’s use in our patients,” Dr. DeBernardo said. “While recent news articles have discussed the rigors of this therapy, the procedure is easier and possibly more effective for gynecologic cancer patients who will be treated after shorter, less intense surgeries, and whose tumors are more sensitive to chemotherapy.”