Patients with gynecologic cancer have new hope in a novel technology now offered at the Seidman Cancer Center at University Hospitals (UH) Case Medical Center. A team of cancer specialists, led by Robert DeBernardo, MD, is among the first in the nation to launch a dedicated program using Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to treat ovarian, endometrial and select other cancers.
Performed immediately following surgery, HIPEC delivers heated chemotherapy through a 'hot bath' into the abdominal cavity, where it can penetrate diseased tissue directly. After the surgeon removes as much visible cancer as possible, a heated, a sterilized chemotherapy solution is circulated throughout the abdomen through a technologically sophisticated perfusion system to destroy the remaining cancer cells.
"This is a new and potentially revolutionary way of treating women with gynecologic cancers, which tend to be quite responsive to chemotherapy," says Dr. DeBernardo, gynecologic oncologist at UH Case Medical Center and Assistant Professor at Case Western Reserve University School of Medicine. "Our preliminary data and experience has been overwhelmingly positive and the therapy has been well-tolerated and effective. HIPEC promises to extend lives in a meaningful way."
HIPEC has been used for years in patients with colon, pseudomyxomas and appendiceal cancers as well as mesothelioma, cancers that in general are not responsive to chemotherapy, but it is now viewed as a promising new treatment for gynecologic malignancy.
UH Case Medical Center plans to launch several Phase One trials for patients this spring, including a first-of-its kind study involving the use of heated chemotherapy for ovarian cancer that has spread to the thoracic cavity, a procedure called Hyperthermic Intrathoracic Chemotherapy (HITEC). These hard-to-treat cancers typically recur and HITEC is performed after minimally invasive lung surgery.
There are several advantages to HIPEC compared to traditional chemotherapy, including improved survival rates for gynecologic cancer patients. Previous studies on the use of chemotherapy given directly into the abdomen, known as intraperitoneal (IP) chemotherapy, have shown an extension of women's lives with advanced ovarian cancer on average of 1.5 years longer than women receiving intravenous (IV) treatment.
HIPEC allows a much higher dose of chemotherapy to permeate the diseased tissue. Because conventional chemotherapy is usually administered intravenously, it circulates throughout the body and is diluted by the time it reaches the abdomen.
"Despite the obvious benefits, only a minority of women currently receive IP therapy due to practical difficulties involved in administering chemo directly in the abdomen following surgery," says Dr. DeBernardo. "HIPEC is now viewed as the next logical step in treating gynecologic cancers such as recurrent and new ovarian and certain endometrial cancers."
Additionally, there has been strong research demonstrating that heating the solution (hyperthermia) also enhances the power of the chemotherapy, improving absorption by tumors and susceptibility of cancer cells. Furthermore, because chemotherapy is kept within the abdomen, HIPEC minimizes the rest of the body's exposure to the treatment, which helps reduce some side effects such as hair loss.
In addition to gynecologic cancer patients, the multidisciplinary HIPEC team, comprised of surgical oncologists, medical oncologists, intensivists, chemotherapy nurses and perfusionists at UH Case Medical Center, is offering the procedure to patients with gastrointestinal cancers and mesothelioma.
"We believe this procedure can improve the odds for our patients and are eager to launch this series of clinical trials to further validate HIPEC's use in our patients," says Dr. DeBernardo. "In our battle against cancer, we keep developing novel methods to outsmart the disease and HIPEC is yet another important tool in our war chest."
A video about UH Case Medical Center's HIPEC program can be viewed at: www.youtube.com/watch?v=kDtc2PKP1wc