Activity of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with cisplatin and doxorubicin in women with recurrent, platinum-resistant ovarian cancer: Preliminary clinical experience

•In a prospective case series, 34 Pressurized IntraPeritoneal Aerosol Chemotherapies (PIPAC) were applied in 18 women with recurrent ovarian cancer.•Survival after 400 days was 62% and mean actuarial survival time was 442 days.•Eight women had repeated PIPAC and objective tumor response was observed in 6.

ObjectiveTo assess the activity of laparoscopic Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) in women with recurrent, platinum-resistant ovarian cancer.MethodsProspective case series using repeated courses q 28-42 days of PIPAC containing cisplatin 7.5 mg/m2 and doxorubicin 1.5 mg/m2 at 12 mm Hg and 37 °C for 30 min. Objective tumor response was defined as tumor regression on histology and peritoneal carcinomatosis index (PCI) improvement on repeated video-laparoscopy.Results34 PIPAC procedures were performed in 18 women, in 8 instances combined with cytoreductive surgery (CRS). Eight women had repeated PIPAC and objective tumor response was observed in 6 (complete remission: 1; partial remission: 2; stable disease: 3). Five adverse events WHO grade ≥ 2 were noted, 3 of them after combined CRS. No perioperative mortality occurred. Median follow-up was 192 days (min. 13-max. 639). Cumulative survival after 400 days was 62% and mean actuarial survival time was 442 days. In a multivariable regression analysis with objective tumor response (yes vs. no) as the dependent variable and PIPAC (1 vs. > 1), patient age (< 75 vs. ≥ 75 years), serum CA-125 (< 1000 vs. > 1000 U/mL), and the presence of ascites (yes vs. no) as independent variables, PIPAC independently predicted objective tumor response.ConclusionPIPAC has activity in women with recurrent, platinum-resistant ovarian cancer and should be investigated in prospective clinical trials.