PIPAC

Pressurized Intraperitoneal Aerosol Chemotherapy( PIPAC) is a new method of giving chemotherapy directly to the peritoneal cavity.

What is PIPAC?

PIPAC is a new method of giving chemotherapy to patients with advanced abdominal cancer, in which chemotherapy is given directly into the abdominal cavity.

Usually, the cancer directed therapy is administered intravenously (through the veins) as a drip. But this method of intraperitoneal chemotherapy is given directly into the abdominal cavity in patients who have cancer spread to the peritoneum, the lining of the abdominal cavity and its organs.

The Procedure

In PIPAC, a chemotherapy vapor is generated using a special device called ‘Capnopen’ and this procedure is performed through laparoscopy. In laparoscopic surgeries, the pressure in the abdominal cavity is raised and the combined effect of this increased pressure and vaporized chemotherapy increases the drug concentration in the cancerous tissue.

A very small dose of chemotherapy is used in this method, leading to lesser side effects. Recent studies have shown that this form of chemotherapy delivery can be as effective as intravenous chemotherapy.

Why PIPAC?

This procedure is simpler compared to the other forms of treatment and the patient has to stay in the hospital for 2 days. Further, the side effects of the treatment are also very minimal and the recovery very quick. It has been also observed that this method has been effective even on patients who couldn’t bear through the process of systemic chemotherapy or have stopped responding to the treatment.

Only 1/10th of the dose of systemic chemotherapy is used in this method, and it produces the same effect and results. Since multiple sessions of PIPAC can be given in the intervals of 6 weeks between each, it can be given alongside routine chemotherapy for better results.

Which patients benefit from PIPAC?

PIPAC is given to patients who have received chemotherapy earlier and usually more than one type of chemotherapy.

This method is actually used to control the symptoms and reduce the disease burden in the cancer patient, for further treatment.

In some cases the tumor can disappear completely or may reduce drastically post PIPAC and the surgical removal of the remaining tumor can be performed effectively. These patients may experience a prolonged survival post treatment.

Can PIPAC cure peritoneal cancer? Can it be performed for all patients with peritoneal cancer?

PIPAC is currently used for controlling symptoms and reducing the disease burden. In some cases the tumor can disappear completely or may reduce drastically and surgical removal of the remaining tumor can be performed. These patients may experience a prolonged survival.

PIPAC is used primarily for patients in whom the disease is extensive and cytoreductive surgery with or without HIPEC is not possible. It is not an alternative for cytoreductive surgery and HIPEC

Can all patients benefit from PIPAC?

Patients who are bed ridden and cannot eat, those who are malnourished or have massive ascites do not benefit from PIPAC. Sometimes there are adhesions between the intestines and abdominal wall due to which laparoscopy is not possible and hence these patients cannot receive PIPAC.

What are the side effects of PIPAC?

Some of the common side effects of PIPAC are abdominal pain, nausea, alteration in the liver and kidney functions. Most of these side effects resolve within a few days. More serious side effects usually do not occur with PIPAC.

Is PIPAC an experimental therapy?

First we should go back to what an experiment means- an experiment is a scientific procedure undertaken to determine something. The effects of PIPAC are known. It has been used in human patients and has been effective. This is in certain conditions mentioned above- when chemotherapy has stopped working or the fluid does not reduce with chemotherapy. In these cases, PIPAC is not experimental.

There are other situations in which the results are not known- like is PIPAC an alternative to chemotherapy? In these situations, it is experimental and its effect is been studied in clinical trials and other experimental studies.

Can PIPAC be used outside clinical trials?

Yes, PIPAC can be used outside clinical trials.

Which therapy is better- HIPEC or PIPAC?

HIPEC is a single treatment usually given during open surgery and higher doses of chemotherapy drugs are used in it. PIPAC is given laparoscopically and multiple sessions are possible, doses of drugs used are lower.

At present, both have different uses. HIPEC is used along with radical surgery that comprises of complete tumor removal (cytoreductive surgery). It can cure certain patients.

PIPAC is used for patients who cannot undergo HIPEC. Its role is palliative. Some times PIPAC is used to shrink the tumor before cytoreductive surgery and HIPEC.

Cytoeductive surgery and HIPEC require a greater expertise to perform compared to PIPAC.