Pressurised intraperitoneal aerosolised chemotherapy (PIPAC) for gastric cancer with peritoneal metastases: A systematic review by the PIPAC UK collaborative

• Published in: Critical reviews in oncology/hematology 2022-12, Vol.180, p.103846, Article 103846
• Main Authors: Case, A., Prosser, S., Peters, C.J., Adams, R., Gwynne, S.
• Format: Article
• Language: English
• Subjects: Aerosols - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Gastric cancer; Humans; Peritoneal metastases; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - secondary; PIPAC; Pressurised intraperitoneal aerosolized chemotherapy; Prospective Studies; Quality of Life; Retrospective Studies; Stomach Neoplasms - drug therapy; Stomach Neoplasms - pathology; United Kingdom
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2022.103846

Gastric cancer with peritoneal metastases (GCPM) carries a poor prognosis. Pressurised Intraperitoneal Aerosolised Chemotherapy (PIPAC) offers pharmacokinetic advantages over intravenous therapy, resulting in higher chemotherapy concentrations in peritoneal deposits, and potentially reduced systemic absorption/toxicity. This review evaluates efficacy, tolerability and impact on quality of life (QOL) of PIPAC for GCPM. Following registration with PROSPERO (CRD42021281500), MEDLINE, EMBASE and The Cochrane Library were searched for PIPAC in patients with peritoneal metastases, in accordance with PRISMA standards Across 18 included reports representing 751 patients with GCPM (4 prospective, 11 retrospective, 3 abstracts, no phase III studies), median overall survival (mOS) was 8 – 19.1 months, 1-year OS 49.8–77.9%, complete response (PRGS1) 0–35% and partial response (PRGS2/3) 0–83.3%. Grade 3 and 4 toxicity was 0.7–25% and 0–4.1% respectively. Three studies assessing QOL reported no significant difference. PIPAC may offer promising survival benefits, toxicity, and QOL for GCPM. [Display omitted] •PIPAC enhances absorption of chemotherapy in peritoneal metastases.•Phase I/II overall survival data is promising for gastric peritoneal carcinomatosis.•Reported rates of PIPAC associated grade ≥ 3 toxicity and death are low.•Quality of life is not impaired by PIPAC treatment.•Phase 3 trials are needed to confirm these findings.