Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC)

Pressurized intraperitoneal aerosol chemotherapy, or PIPAC, is a new treatment technique that gives chemotherapy in the form of a pressurized aerosol, or spray.

PIPAC is safe, and most people handle it well. It has fewer side effects than regular chemotherapy. Complications are rare. So far, results look promising.

Who Is It For?

PIPAC is new, so doctors are still learning who it may work best for. It’s most often used for end-stage peritoneal carcinomatosis, or cancer in the thin layer of tissue that lines your abdomen (belly) and covers most of the organs in it. You usually get it when cancer in your digestive system or female reproductive organs spreads.

It may be an option if you have stomach cancer; platinum-resistant, recurrent ovarian cancer (a type that comes back 6 months after treatment with platinum-based chemotherapy); or colorectal cancer, and surgery isn’t an option for you.

It may also help if tumors in your stomach, pancreas, liver, or appendix spread to your abdomen.

Your doctor will tell you if PIPAC is an option for you.

Where Do You Get PIPAC?

You can only get PIPAC in a few places. The first PIPAC performed in the United States was in December 2019, at the Mayo Clinic in Jacksonville, FL. More centers may start offering PIPAC in the near future.

How Do You Prepare for PIPAC?

Your medical team may schedule you for PIPAC every 6-8 weeks. If you’re also getting a stem cell transplant, you may have to wait 7 to 10 days between treatments to let the medication wash out of your system. (Your doctor will call this a washout period.)

The doctor may give you medication to prevent blood clots the night before PIPAC. Right before the procedure, you’ll get medicine to help you sleep.

What Happens During PIPAC?

Most of the time, you get chemotherapy as a liquid. Your doctor injects or infuses the drug into a vein. You may have heard it called a systemic treatment because it travels to the rest of your body through your bloodstream.

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PIPAC is a simple procedure that takes less than an hour. It’s known as a minimally invasive surgery because the doctor only has to make small cuts. They’ll use them to put a tube called a trochar inside your belly. It will help them guide a camera, or laparoscope, and other surgical tools for the procedure.

During PIPAC, the doctor injects the medication into your belly through a nebulizer, a machine that turns liquid medicine into a fine mist. That helps it go more deeply into your body. Once the drug is inside your body, you’ll wait for 30 minutes as it goes to work.

Doctors are studying a new, faster system with a shorter wait time of 2-3 minutes. It may be offered in the future.

What Can You Expect After PIPAC?

You may stay in the hospital overnight after you have PIPAC. Most people handle the treatment well.

Side effects are few. You could have some discomfort, a slight pain in your belly, or mild nausea.

PIPAC can improve your quality of life. The procedure may ease symptoms like belly pain and swelling. If you do feel pain after PIPAC, it shouldn’t last long.

With PIPAC, you may have fewer side effects than you do with regular chemotherapy, like nausea, vomiting, diarrhea, and hair loss.

What’s the Long-Term Outlook for PIPAC?

While it’s still new, PIPAC’s results are promising. In a recent study, more than half the people who had PIPAC reported smaller tumors and relief of symptoms.

We need more research to understand what happens with different tumors. Experts should know more about PIPAC after randomized clinical trials and large studies comparing PIPAC’s results with regular chemotherapy for specific tumors.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on June 18, 2020

Sources

SOURCES:
Journal of Gastric Cancer: “Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in Gastric Cancer Patients with Peritoneal Metastasis (PM): Results of a Single-Center Experience and Register Study.”

BMC Cancer: “Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for the treatment of malignant mesothelioma.”

Biomedicines: “Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with Oxaliplatin, Cisplatin, and Doxorubicin in Patients with Peritoneal Carcinomatosis: An Open-Label, Single-Arm, Phase II Clinical Trial.”

Sheba Medical Center: “PIPAC -- Innovative, direct delivery of chemotherapy for peritoneal metastasis.”

Medstar Georgetown Cancer Institute: “Peritoneal Carcinomatosis.”

Society of American Gastrointestinal and Endoscopic Surgeons: “Indications And Surgical Results Of Pressurized Intraperitoneal Aerosol Chemotherapy (Pipac) For Palliative Therapy Of Peritoneal Metastasis After 748 Consecutive Procedures,” “Pressurized Intra-Peritoneal Aerosol Chemotherapy (Pipac) For Carcinomatosis Patients: A Laparoscopically Administered Palliative Treatment That Is Well Tolerated, Repeatable, And Safer Than Systemic Chemotherapy.”

Gynecologic Oncology: “ ‘Platinum resistant’ ovarian cancer: What is it, who to treat and how to measure benefit?”

American Cancer Society: “Systemic Chemotherapy for Basal and Squamous Cell Skin Cancers.”

KidsHealth: “What's the Difference Between a Nebulizer and an Inhaler?”

News Release, MD Anderson Cancer Center Madrid.

American Society of Colon & Rectal Surgeons: “Laparoscopic Surgery -- What is it?”

International Society for the Study of Pleura and Peritoneum: “First PIPAC in the United States of America, Mayo Clinic.”

Diseases of the Colon & Rectum: “Pressurized Intraperitoneal Aerosol Chemotherapy, a Palliative Treatment Approach for Patients With Peritoneal Carcinomatosis: Description of Method and Systematic Review of Literature.”

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