Descriptive review of current practices and prognostic factors in patients with ovarian cancer treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC): a multicentric, retrospective, cohort of 234 patients

IntroductionOvarian cancer (OC) is the primary cause of mortality in women diagnosed with gynecological cancer. Our study assessed pressurized intraperitoneal aerosol chemotherapy (PIPAC) as treatment for peritoneal surface metastases (PSM) from recurrent or progressive OC and conducted survival analyses to identify prognostic factors.Material and methodsThis retrospective cohort study, conducted across 18 international centers, analyzed the clinical practices of patients receiving palliative treatment for PSM from OC who underwent PIPAC. All patients were initially treated appropriately outside any clinical trial setting. Feasibility, safety, and morbidity were evaluated along with objective endpoints of oncological response. Multivariate analysis identified prognostic factors for OS and PFS.ResultsFrom 2015-2020, 234 consecutive patients were studied, from which 192 patients were included and stratified by platinum sensitivity for analysis. Patients with early recurrence, within one postoperative month, were excluded. Baseline characteristics were similar between the groups regarding platinum sensitivity (platinum sensitive (PS) and resistant (PR)), but chemotherapy frequency differed, as did PCI before PIPAC. Median PCI decreased in both groups after three cycles of PIPAC (PS 16 vs. 12, p < 0.001; PR 24 vs. 20, p = 0.009). Overall morbidity was 22%, with few severe complications (4-8%) or mortality (0-3%). Higher pathological response and longer OS (22 vs. 11m, p = 0.012) and PFS (12 vs. 7m, p = 0.033) were observed in the PS group. Multivariate analysis (OS/PFS) identified ascites (HR 4.02, p < 0.001/5.22, p < 0.001), positive cytology at first PIPAC (HR 3.91, p = 0.002/1.96, p = 0.035), and ≥ 3 PIPACs (HR 0.30, p = 0.002/0.48, p = 0.017) as independent prognostic factors of overall survival/progression-free survival.ConclusionsWith low morbidity and mortality rates, PIPAC is a safe option for palliative treatment of advanced ovarian cancer. Promising results were observed after 3 PIPAC, which did improve the peritoneal burden. However, further research is needed to evaluate the potential role of PIPAC as an independent prognostic factor

Consensus statement for treatment protocols in pressurized intraperitoneal aerosol chemotherapy (PIPAC)

Objectives: Safe implementation and thorough evaluation of new treatments require prospective data monitoring and standardization of treatments. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising alternative for the treatment of patients with peritoneal disease with an increasing number of suggested drug regimens. The aim was to reach expert consensus on current PIPAC treatment protocols and to define the most important research topics. Methods: The expert panel included the most active PIPAC centers, organizers of PIPAC courses and principal investigators of prospective studies on PIPAC. A comprehensive literature review served as base for a two-day hybrid consensus meeting which was accompanied by a modified three-round Delphi process. Consensus bar was set at 70% for combined (strong and weak) positive or negative votes according to GRADE. Research questions were prioritized from 0 to 10 (highest importance). Results: Twenty-two out of 26 invited experts completed the entire consensus process. Consensus was reached for 10/10 final questions. The combination of doxorubicin (2.1 mg/m(2)) and cisplatin (10.5 mg/m(2)) was endorsed by 20/ 22 experts (90.9%). 16/22 (72.7%) supported oxaliplatin at 120 with potential reduction to 90 mg/m(2) (frail patients), and 77.2% suggested PIPAC-Ox in combination with 5-FU. Mitomycin-C and Nab-paclitaxel were favoured as alternative regimens. The most important research questions concerned PIPAC conditions (n=3), standard (n=4) and alternative regimens (n=5) and efficacy of PIPAC treatment (n=2); 8/14 were given a priority of >= 8/10. Conclusions: The current consensus should help to limit heterogeneity of treatment protocols but underlines the utmost importance of further research

Assesment of hyperthermic intraperitoneal chemotherapy in ovarian cancer

L'association chirurgie de cytoréduction et chimiohyperthermie intrapéritonéale (CHIP) n'est pas un traitement reconnu de la carcinose péritonéale (CP) d'origine ovarienne. En France et dans le monde, des centres experts dans la prise en charge des CP ont proposé ce traitement combiné à des patientes avec un carcinome épithélial de l'ovaire (CEO). Le but de ce travail était, au travers d'études expérimentales et cliniques, de rapporter l'expérience des centres français en élaborant un registre national de patientes traitées pour un carcinome épithélial de l'ovaire par CRS et CHIP et d'expliquer l'insuffisance rénale post-opératoire qui est une toxicité spécifique du cisplatine. Nous faisons tout d'abord un état des lieux de l'utilisation de la CHIP dans le traitement du CEO au travers de ses indications et des données de survie et de morbi-mortalité publiées dans la littérature. Puis, nous rapportons les résultats du registre national « Chip-Ovaires » en étudiant successivement plusieurs populations d'intérêt ( première récidive, adénocarcinomes mucineux). Nous traitons de façon distincte les carcinomes papillaires séreux du péritoine en comparant leur présentation clinique à celle des CEO. Un chapitre est consacré à l'étude prospective de la qualité de vie des patientes dans l'année qui suit cette procédure combinée. Enfin, nous avons développé de façon collaborative avec plusieurs services du Centre Hospitalier Lyon sud, un logiciel de cotation automatisée de la carcinose péritonéale adapté aux spécificités du cancer de l'ovaire, CARCASE, qui a vocation à être déployé dans un premier temps dans des centres français, puis dans sa version anglophone, dans des centres européensCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is not a standard treatment of peritoneal carcinomatosis (PC) from ovarian origin. Since the first steps of HIPEC, in France and in the world, experts centers have treated patients with ovarian cancer using HIPEC. The aim of this work based on fundamental and clinical studies was to report the experience of tertiary centers in HIPEC and ovarian cancer and to explore the pharmacokinetics of cisplatinum in HIPEC. First we reviewed the literature in order to stocks on the indications, the reported survival and the morbidmortality of this combined procedure in ovarian cancer. Then we reported the results of the French national registry and we focused on different subgroups ( fisrt relapse, mucinous adenocarcinoma). We studied separately the primitive peritoneal serous carcinoma and we compared their PC distribution to these of ovarian cancer. We studied prospectively the quality of life of patients treated by CRS and HIPEC in the post-operative first year. Finally, We designed a professional software called "CAR-CASE" (Carcinomatosis Auto Scoring System), to automatically calculate the PC

Carcinomes ovariens récurrents et chimiorésistants traités par chirurgie de cytoréduction et chimiohyperthermie intrapéritonéale (une étude prospective multicentrique de 246 patientes)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Multi-Disciplinary Care Planning of Ovarian Cancer in Older Patients: General Statement-A Position Paper from SOFOG-GINECO-FRANCOGYN-SFPO

International audienceIn this position paper the Société Francophone d’OncoGériatrie (SOFOG; French-speaking oncogeriatric society), the Société Française de Pharmacie Oncologique (SFPO, French society for oncology pharmacy), the Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO, National Investigators’ Group for Studies in Ovarian and Breast Cancer) and the Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN) propose a multi-disciplinary care planning of ovarian cancer in older patients. The treatment pathway is based on four successive decisional nodes (diagnosis, resectability assessment, operability assessment, adjuvant, and maintenance treatment decision) implying multidisciplinarity and adaptation of the treatment plan according to the patient’s geriatric covariates and her motivation towards treatment. Specific attention must be paid to geriatric intervention, supportive care and pharmaceutical conciliation. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes

Early Preinvasive Lesions in Ovarian Cancer

Faced with the catastrophic prognosis for ovarian cancer due to the fact that it is most often diagnosed late at the peritoneal carcinomatosis stage, screening and early detection could probably reduce the mortality rate. A better understanding of the molecular characteristics of the different ovarian cancer subtypes and their specific molecular signatures is indispensable prior to development of new screening strategies. We discuss here the early natural history of ovarian cancer and its origins

Ovarian cancer in the older patient: where are we now? What to do next?

In recent years, major advances have been made toward the individualization of epithelial ovarian cancer care, leading to an overall improvement of patient outcomes. However, real-life data indicate that the oldest populations do not benefit from this, due to aspects related to cancer (more aggressive histopathological features), treatment (i.e. frequently suboptimal), and the host (increased toxicities in patients with lower physiological reserve). A specific risk–benefit perspective should therefore be taken when considering surgery, chemotherapy, and maintenance treatments: the decision for cytoreductive surgery should include geriatric vulnerability and surgical complexity, neo-adjuvant chemotherapy being an option when primary surgery appears at high risk; carboplatin paclitaxel association remains the standard even in vulnerable older patients; and bevacizumab and poly(ADP-ribose) polymerase inhibitors maintenance are interesting options provided they are prescribed according to their indications with a close monitoring of their toxicities. Future studies should aim to individualize care without limiting access of older patients to innovation. A specific focus is needed on age-specific translational analyses (focusing on tumor mutational burden and impaired biological pathways), a better patient stratification according to geriatric parameters, an adaptation of both oncological treatment and geriatric interventions, and treatment adaptations not a priori but according to formal pharmacokinetic data