Podcasts about Hipec

We're bringing the heat as Dr. Laura Enomoto, Dr. Melanie Ongchin and Dr. Alissa Greenbaum discuss key highlights and updates in Peritoneal Surface Malignancy and HIPEC presented at the 2025 SSO Annual Meeting. This episode explores evolving evidence, multidisciplinary approaches, and clinical trials shaping the future of care in this complex disease space

In this episode of the Onc Now Podcast, host Jonathan Sackier is joined by Donal Brennan, a leader in gynaecological oncology and Principal Investigator at Systems Biology Ireland. Together, they discuss advances in ovarian cancer surgery, including cytoreductive techniques and hyperthermic intraperitoneal chemotherapy (HIPEC), as well as the impact of obesity on cancer development and treatment strategies.  Brennan also shares insights on platinum resistance in ovarian cancer, the FeMMe trial exploring weight loss as a treatment for endometrial cancer, and his innovative approaches in surgical oncology.  This episode is essential listening for anyone interested in the future of cancer treatment, innovation in surgery, and patient-centred care.  Timestamps:  (00:00) - Introduction  (01:51) - Music debates in the surgical theatre  (03:42) - Evolution of surgical techniques in ovarian cancer  (06:32) - The importance of early diagnosis  (08:18) - State-of-the-art on HIPEC in gynaecological oncology  (11:36) - Obesity's impact on cancer diagnosis and treatment  (19:06) - The FeMMe trial: weight loss as a treatment for endometrial cancer  (21:47) - Platinum resistance in ovarian cancer and future therapies  (28:14) - Innovation in gynaecological surgery and medical technology  (29:53) - The COMFORT trial: mental health and cancer treatment  (33:24) - Biggest challenges and opportunities in gynaecological oncology research  (37:42) - Three wishes for the future of cancer treatment 

Dr. Nawar Latif offers a nuanced overview of heated intraperitoneal chemotherapy, or HIPEC, as an adjunct to surgery in women with ovarian cancer. The introduction of heated chemotherapy at the peritoneum greatly increases its absorption and minimizes the toxicity of therapy.

Dr. Stéphanie Gaillard and Dr. Bill Tew share updates to the evidence-based guideline on neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer. They highlight recommendations across ten clinical questions, addressing initial assessment, primary cytoreductive surgery, neoadjuvant chemotherapy (NACT), tests and/or procedures that should be completed before NACT, preferred chemotherapy regimens, timing of interval cytoreductive surgery (ICS), hyperthermic intraperitoneal chemotherapy (HIPEC), post ICS-chemotherapy, maintenance therapy, and options for those without a clinical response to NACT. They highlight the evidence supporting these recommendations and emphasize the importance of this guideline for clinicians and patients. Read the full guideline update, “Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: ASCO Guideline Update” at www.asco.org/gynecologic-cancer-guidelines." TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/genitourinary-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology. Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Stéphanie Gaillard from Johns Hopkins University and Dr. Bill Tew from Memorial Sloan Kettering Cancer Center, co-chairs on “Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: ASCO Guideline Update.” Thank you for being here today, Dr. Gaillard and Dr. Tew. Dr. Bill Tew: Thank you for having us. Dr. Stéphanie Gaillard: Yeah, thank you. It's great to be here. Brittany Harvey: Great. Then, before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Gaillard and Dr. Tew, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then to dive into the content here, first, Dr. Tew, could you describe what prompted this update to the neoadjuvant chemotherapy for ovarian cancer guideline? And what is the scope of this update? Dr. Bill Tew: Yeah. It's been almost a decade since ASCO first published its neoadjuvant chemotherapy guidelines for women with newly diagnosed ovarian cancer, and over that 10-year period, there's really been a major shift in how oncologists treat patients in the U.S. If you look at the National Cancer Database, between 2010 and 2021, the proportion of patients with advanced ovarian cancer who underwent primary surgery fell from about 70% to about 37%. And there's been a doubling in the amount of neoadjuvant chemotherapy used. So we wanted to take a look at that and really both highlight the appropriate patient populations for primary surgery versus new adjuvant chemotherapy, as well as review any studies that have been published since then. There's been, I think, about 61 trials published, nine randomized trials alone in the last 10 years. And the scope of the guideline was really not only the neoadjuvant chemotherapy and surgical questions, but also to touch upon some new treatments that have come to the forefront in newly diagnosed ovarian cancer, including heated intraperitoneal chemotherapy or HIPEC, as well as the integration of maintenance therapy, particularly bevacizumab and PARP inhibitors. Brittany Harvey: Understood. That's a large amount of new evidence to review in this Update. Then, next, Dr. Gaillard, I'd like to review the key recommendations across the 10 clinical questions that the guideline addressed. So, starting with: What is recommended regarding initial assessment for patients with newly diagnosed pelvic masses and/or upper abdominal or peritoneal disease? Dr. Stéphanie Gaillard: Sure. So in talking about the first guidelines, the first one that we addressed was how to do the initial assessment for these patients. And first, and probably most critically, it's important to recognize that these patients really should be evaluated by a gynecologic oncologist prior to initiation of any therapy, whether that means a primary cytoreductive surgery or neoadjuvant chemotherapy, because really, they are the best ones to determine the pathway that the patient should take. The initial assessment should involve a CA-125, a CT of the abdomen and pelvis with oral and IV contrast, if not contraindicated, and then also chest imaging, in which a CT is really the preferred modality. And that helps to evaluate the extent of disease and the feasibility of the surgical resection. Now, there may be some other tools that could be helpful to also refine this assessment. So, for example, a laparoscopy can really help to determine the feasibility of surgical resection as well as the extent of disease. Further imaging, such as diffusion-weighted MRI or FDG-PET scans can be helpful, as well as ultrasounds. And then also an endometrial biopsy. And that was newly added because there really has been a divergence of treatment for endometrial cancer versus ovarian cancer. And so it's really important to determine upfront where the source of the disease is coming from. Brittany Harvey: I appreciate you describing those recommendations surrounding initial assessment. So following this assessment, Dr. Tew, which patients with newly diagnosed advanced epithelial ovarian cancer should be recommended primary cytoreductive surgery? Dr. Bill Tew: The key thing here is if the GYN oncology surgeon feels that they have a high likelihood of achieving a complete cytoreduction with acceptable morbidity, the panel overwhelmingly agrees that primary cytoreduction surgery should be recommended over chemotherapy. And we know that surgery is really the cornerstone to achieving clinical remission. And our concern is that neoadjuvant chemotherapy may be overused in this fit population. Sometimes it is challenging to determine truly if a patient has a high likelihood of complete cytoreduction or what is acceptable morbidity. But an evaluation with performance status, fitness, looking at age or frailty, nutritional status, as well as a review of imaging studies to plan and determine for who is the right patient for primary surgery is key. Brittany Harvey: And then the title of this guideline, Dr. Gaillard, for which patients is neoadjuvant chemotherapy recommended? Dr. Stéphanie Gaillard: Yeah. So there's really two patient populations that we think are best suited to receive neoadjuvant chemotherapy. Those may be patients who are fit for a primary cytoreductive surgery, but they're unlikely to have a complete cytoreduction if they were to go to surgery directly. And so that's where neoadjuvant chemotherapy can be very helpful in terms of increasing the ability to obtain a complete cytoreduction. The second population is those who are newly diagnosed who have a high perioperative risk, and so they're not fit to go to surgery directly. And so it may be better to start with neoadjuvant chemotherapy and then do an interval cytoreductive surgery. Again, I just want to emphasize the importance of including a gynecologic oncologist when making these determinations for patients. Brittany Harvey: Absolutely. So then the next clinical question. Dr. Tew, for those patients with newly diagnosed stage 3 to 4 epithelial ovarian cancer, what tests and or procedures are recommended before neoadjuvant chemotherapy is delivered? Dr. Bill Tew: The key test is to confirm the proper diagnosis, and that requires histological confirmation with a core biopsy. And this was a point the panel strongly emphasized, which is a core biopsy is a much better diagnostic tool compared to cytology alone. But there will be cases, exceptional cases, where a core biopsy cannot be performed. And in those settings, cytology combined with serum CA-125 and CEA is acceptable to exclude a non-gynecologic cancer. The other reason why cord biopsy is strongly preferred is because we already need to start thinking about germline and somatic testing for BRCA1 and 2. This information is important as we start to think about maintenance strategies for our patients. And so having that information early can help tailor the first-line chemotherapy regimen. Brittany Harvey: So then you've described who should be receiving neoadjuvant chemotherapy, but Dr. Gaillard, for those who are receiving neoadjuvant chemo, what is the preferred chemotherapy regimen? And then what does the expert panel recommend regarding timing of interval cytoreductive surgery? Dr. Stéphanie Gaillard: Sure. So for neoadjuvant chemotherapy, we generally recommend a platinum taxane doublet. This is especially important for patients with high grade serous or endometrioid ovarian cancers, and that's really because this is what the studies had used in the neoadjuvant trials. We recognize, however, that sometimes there are individual patient factors, such as advanced age or frailty, or certain disease factors such as the stage or rare histology that may shift what is used in terms of chemotherapy, but the recommendation is to try to stick as much as possible to the platinum taxane doublet. And then in terms of the timing of interval cytoreductive surgery, this was something that the panel discussed quite a bit and really felt that it should be performed after four or fewer cycles of neoadjuvant chemotherapy, especially in patients who've had a response to chemotherapy or stable disease. Sometimes alternative timing of surgery can be considered based on some patient centered factors, but those really haven't been prospectively evaluated. The studies that looked at neoadjuvant chemotherapy usually did the interval cytoreductive surgery after three or four cycles of chemotherapy. Brittany Harvey: For those patients who are receiving interval cytoreductive surgery, Dr. Tew, earlier in the podcast episode, you mentioned a new therapy. What is recommended regarding hyperthermic intraperitoneal chemotherapy? Dr. Bill Tew: Yeah, or simply HIPEC as everyone refers to it. You know, HIPEC isn't really a new therapy. HIPEC is a one-time perfusion of cisplatin, which is a chemotherapy that has been a standard treatment for ovarian cancer for decades. But the chemotherapy is heated and used as a wash during the interval cytoreductive surgery. And since our last guideline, there has been a publication of a randomized trial that looked at the use of HIPEC in this setting. And in that study there was improved disease-free and overall survival among the patients that underwent HIPEC versus those that did not. So we wanted to at least emphasize this data. But we also wanted to recognize that HIPEC may not be available at all sites. It's resource-intensive. It requires a patient to be medically fit for it, particularly renal function and performance status. And so it's something that could be discussed with the patient as an option in the interval cytoreductive surgery. One other point, the use of HIPEC during primary surgery or later lines of therapy still is unknown. And the other point is this HIPEC trial came prior to the introduction of maintenance PARP inhibitors. So there's still a lot of unknowns, but it is a reasonable option to discuss with appropriate patients. Brittany Harvey: I appreciate you reviewing that data and what that updated recommendation is from the panel. So then, Dr. Gaillard, after patients have received neoadjuvant chemotherapy and interval cytoreductive surgery, what is the post ICS chemotherapy recommended? Dr. Stéphanie Gaillard: The panel recommends some post ICS chemotherapy, as you mentioned. This is typically to continue the same chemotherapy that was done as neoadjuvant chemotherapy and so preferably platinum and taxane. And typically we recommend a total of six cycles of treatment, although the exact number of cycles that is given post-surgery can be adjusted based on different patient factors and their response to treatment. Importantly, also, timing is a factor, and we recommend that postoperative chemotherapy begin within four to six weeks after surgery, if at all feasible. Brittany Harvey: Absolutely. Those timing recommendations are key as well. So then, Dr. Tew, you mentioned this briefly earlier, but what is the role of maintenance therapy? Dr. Bill Tew: Maintenance therapy could be a full podcast plus of discussion, and it's complicated, but we did want to include it in this guideline in part because the determination of whether to continue treatment after completion of surgery and platinum based therapy is key as one is delivering care in the upfront setting. So first off, when we say maintenance therapy, we are typically referring to PARP inhibitors or bevacizumab. And I would refer listeners to the “ASCO PARP Inhibitor Guideline” that was updated about two years ago, as well as look at the FDA-approved label indications. But in general, PARP inhibitors, whether it's olaparib or niraparib, single agent or olaparib with bevacizumab, are standard treatments as maintenance, particularly in those patients with a germline or somatic BRCA mutation or those with an HRD score positive. And so it's really important that we emphasize germline and somatic BRCA testing for all patients with newly diagnosed ovarian cancer so that one can prepare for the use of maintenance therapy or not. And the other point is, as far as bevacizumab, bevacizumab is typically initiated during the chemotherapy section of first-line treatment. And in the guidelines we gave specific recommendations as far as when to start bevacizumab and in what patient population. Brittany Harvey: Great. Yes. And the PARP inhibitors guideline you mentioned is available on the ASCO guidelines website and we can provide a link in the show notes for our listeners. So then, the last clinical question, Dr. Gaillard, what treatment options are available for patients without a clinical response to neoadjuvant chemotherapy? Dr. Stéphanie Gaillard: Yeah, this is a tough situation. And so it's important to remember that ovarian cancer typically does respond to chemotherapy initially. And so it's unusual to have progressive disease to neoadjuvant chemotherapy. So it's really important that if someone has progressive disease that we question whether we really have the right diagnosis. And so it's important to, I think at that point, obtain another biopsy and make sure that we know what we're really dealing with. In addition, this is where Dr. Tew mentioned getting the molecular profiling and genetic testing early in the course of disease. If that hasn't been done at this point in time, it's worth doing that in this setting so that that can also potentially help guide options for patients. And patients who are in those situations, really, the options are other chemotherapy regimens, clinical trials may be an option, or in some situations, if they have really rapidly progressing disease that isn't amenable to further therapy, then initiation of end-of-life care would be appropriate. Brittany Harvey: I appreciate you both for reviewing all of these recommendations and options for patients with advanced ovarian cancer. So then to wrap us up, in your view, what is both the importance of this guideline update and how will it impact clinicians and patients with advanced ovarian cancer? Dr. Bill Tew: Well, first off, I'm very proud of this guideline and the panel that I work with and Dr. Gaillard, my co-chair. The guideline really pulls together nicely all the evidence in a simple format for oncologists to generate a plan and determine what's the best step for patients. The treatment of ovarian cancer, newly diagnosed, is really a team approach - surgeons, medical oncologists, and sometimes even general gynecologists - and understanding the data is key, as well as the advances in maintenance therapy and HIPEC. Dr. Stéphanie Gaillard: For my part, I'd say we hope that the update really provides physicians with best practice recommendations as they navigate neoadjuvant chemotherapy decisions for their patients who are newly diagnosed with ovarian cancer. There is a lot of data out there and so we hope that we've synthesized it in a way that makes it easier to digest. And along that regard, I really wanted to give a special shout out to Christina Lacchetti, who just put in a tremendous effort in putting these guidelines together and in helping to coordinate the panel. And so we really owe a lot to her in this effort. Dr. Bill Tew: Indeed. And ASCO, as always, helps guide and build a great resource for the oncology community. Brittany Harvey: Absolutely. Yes, we hope this is a useful tool for clinicians. And I want to thank you both for the large amount of work you put in to update this evidence-based guideline. And thank you for your time today, Dr. Gaillard and Dr. Tew. Dr. Stéphanie Gaillard: Thank you. Dr. Bill Tew: Thank you for having us. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast. To read the full guideline, go to www.asco.org/gynecologic-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

In this episode of SurgOnc Today®, Dr. Sinziana Dumitra discusses the evaluation and management of patients with peritoneal metastases from MSI-high colorectal cancer with Dr. Joshua Leinwand and Dr. Zachary Brown, including the role of HIPEC, immunotherapy, and differences in clinical characteristics and outcomes compared with microsatellite-stable disease.

Innovative Ansätze in der Onkologie verdienen besondere Aufmerksamkeit. In dieser Folge bespreche ich gemeinsam mit Prof. Hünerbein aus Oranienburg die Ergebnisse einer retrospektiven Kohortenstudie aus den USA. Im Fokus steht der Einsatz der laparoskopischen HIPEC-Therapie bei Magenkrebs mit Peritonealmetastasen – ein Verfahren, das vielversprechende Sicherheit und perioperative Ergebnisse zeigt und die chirurgische Onkologie bereichern könnte. Viel Freude beim Hören! Moderation: Christoph Paasch Gast: Prof. Dr. med. Peter Hünerbein (Oranienburg) Besprochene Publikation: Read MD, Drake J, Hashemipour G, et al. Initial Experience Using Laparoscopic HIPEC for Gastric Cancer with Peritoneal Metastasis: Safety and Outcomes. Ann Surg Oncol. 2024;31:3750–3757. doi: 10.1245/s10434-024-15102-5. Unter folgendem Link können bei der Landesärztekammer Brandenburg 2 Fortbildungspunkte erworben werden. Der Kursinhalt umfasst stets 3 Folgen: https://lernportal.laekb.de/goto.php?target=crs_3487&client_id=laekb.

Voici le 8ème épisode de notre série de Podcast La Pause Dig' !

When Celeste Guptill believed her stomach was swollen a bit more than usual following the birth of her tenth child, she thought it might be due to age or some sort of gastrointestinal issue.  However, a CT scan revealed a tumor leading to a diagnosis of pseudomyxoma peritonei (PMP), a rare type of appendix cancer.  The tumor was surgically removed, but Celeste was fortunate to find a specialist who performed a second procedure called HIPEC, which included heated chemotherapy.  Cancer-free for more than five years, Celeste says that physically, she can do everything she could do prior to her diagnosis.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Lot Aronson and Willemien van Driel to discuss OVHIPEC1 overall survival analysis. Dr. van Driel is a gynecological oncologist at the Netherlands Cancer Institute since 2004 and has, amongst others, a special interest in determining the role of HIPEC in the treatment of patients with advanced ovarian carcinoma and is PI of the OVHIPEC 1 and OVHIPEC 2 study. Dr. Aronson is a medical doctor currently pursuing a PhD in Gynaecological Oncology at the Netherlands Cancer Institute in Amsterdam. Her research focuses on hyperthermic intraperitoneal chemotherapy (HIPEC) as well as immunotherapy in primary advanced ovarian cancer.    Highlights: The long-term survival analysis of the OVIHPEC-1 study confirms the significant improvement in progression-free and overall survival when adding HIPEC to interval cytoreductive surgery in patients with FIGO stage III ovarian carcinoma for whom primary cytoreduction is not considered feasible due to extensive disease. Neither the number of lines nor the type of subsequent treatment for recurrence differed between the treatment groups. Therefore, the observed improvement in overall survival is unlikely to be attributable a difference in subsequent therapies. Identification of biomarkers (e.g. BRCA/HRD status) to select patients for HIPEC and the combination of HIPEC with PARP inhibitors warrants further investigation.

Welcome to Season 3 of the Winter Faith Podcast. In this episode, Andy previews the upcoming season of the show and provides a brief health update. Three years ago today Andy was at Duke Cancer Center recovering from his HIPEC surgery. Today he is running around and coaching his kids soccer/football team. Please leave a review on Facebook or Apple Podcasts if you like what you hear. Also share the show with your friends, or enemies! The Winter Faith Podcast believes all people have seasons of Winter Faith and that doubt is an essential part of faith. Follow @winterfaithpodcast. Podcast music by Josh Cleveland. Podcast artwork by Sarah Dolislager. Created by Andrew Frazier in 2017.

In this episode of SurgOnc Today®, Dr. Melanie Ongchin from the University of Pittsburgh, Dr. Trang Nguyen from Washington University, and Dr. Molly Kledzik from WVU are joined by Ms. Lindsay Barad, a patient and advocate for PMP Pals. Diagnosed with LAMN with PMP, Lindsay shares her unique perspective on the patient experience following CRS/HIPEC, emphasizing the challenges and considerations of young female patients regarding fertility.

In this JCO Precision Oncology Article Insights episode, Fergus Keane provides a summary on "Multi-Institutional Study Evaluating the Role of Circulating Tumor DNA in the Management of Appendiceal Cancers" by Belmont, et al published on May 9th, 2024. TRANSCRIPT  Fergus Keane: Hello and welcome to JCO Precision Oncology Article Insights. I'm your host, Fergus Keane, an ASCO editorial fellow. Today I will be providing a summary of the article entitled, "Multi-Institutional Study Evaluating the Role of Circulating Tumor DNA in the Management of Appendiceal Cancers" by Dr. Erika Belmont and colleagues.  While appendiceal cancers represent an uncommon diagnosis, the incidence has been rising, with now over 3000 new cases per year diagnosed in the United States. The management of appendiceal cancers includes surgical resection for localized tumors and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, also known as HIPEC, for select patients with peritoneal metastasis. For patients with higher grade appendiceal cancers, systemic therapy is often included in the treatment paradigm. However, little data pertaining to the optimal treatment regimens exists.  Despite best practice, disease recurrence within three years of surgery will be observed in about 70% of cases of appendiceal cancers. The current conventional methods for surveillance for both detection of recurrence as well as for assessment of response to systemic therapy are using cross sectional imaging and serum tumor markers. These methods are limited and there is a recognition that more accurate biomarkers are required. Circulating tumor DNA, also known as liquid biopsies, refer to shed tumor DNA identified in the plasma. Several ctDNA assays exist, including tumor agnostic assays and tumor informed assays, the latter of which assess presence of personalized tumor derived mutations. The utility of circulating tumor DNA has been studied across several different cancer types and in several different disease settings, for instance in lung cancer and colorectal cancer. However, it has not been well demonstrated to date in appendiceal cancers.  This study aimed to investigate the role of the Signatera ctDNA assay in patients with appendiceal cancer. Specifically, the authors aimed to evaluate factors associated with circulating tumor DNA detection and the association between ctDNA and recurrence free survival after surgery. Their hypothesis was twofold, firstly, that circulating tumor DNA detection would be reduced in patients who received recent systemic therapy, and secondly, that circulating tumor DNA detection after cytoreductive surgery and HIPEC would be associated with a shorter recurrence free survival across all appendiceal cancer grades. The study design was a retrospective review of patients with appendiceal cancers treated at MD Anderson Cancer Center in Texas and the University of Chicago who underwent circulating tumor DNA testing between January 2019 and December 2022. Clinical, pathologic and treatment related information was collected for all patients. Regarding patient treatment, all patients received treatment as per the consensus recommendations at both cancer centers. Diagnostic evaluation was with CT or MRI imaging and serum tumor markers. Diagnostic laparoscopy was performed to evaluate for the presence of peritoneal metastases. The patient treatment plans were determined via MDT tumor board discussions and cytoreductive surgery, and HIPEC was offered with curative intent to eligible patients.  Systemic therapy with 5-FU based doublet or triplet therapy with or without VEGF inhibitors was offered to patients with grade two or three tumors and with a good performance status. HIPEC protocols involved the use of mitomycin C. Postoperative surveillance involved cross sectional imaging and tumor marker evaluation every three months for two years and thereafter every six months if the patients remain disease-free. Circulating tumor DNA testing was offered at the discretion of the treating physician, typically every three months after surgery. The Signatera assay is a personalized, multiplexed, PCR based next generation sequencing platform. Three major analyses were performed. Number one, the frequency of any time ctDNA detection was evaluated in patients with ctDNA assays drawn at the time of radiographic or laparoscopically identifiable disease. Number two, the correlation between preoperative ctDNA levels and intraoperative peritoneal cancer index was evaluated in patients with peritoneal metastases. The third analysis involves the association between circulating tumor DNA presence drawn within one year of optimal resection.  A total of 402 plasma samples were obtained from 94 patients from the two centers. Most patients had grade 2 or 3 appendiceal cancers and 85% underwent surgery. Most patients had peritoneal metastases. 50 patients had circulating tumor DNA assessment in the presence of stage 4 disease, included in this, 13 patients were tested preoperatively, 26 patients who developed recurrence after surgery were included, and 11 patients who did not undergo surgery. In total, circulating tumor DNA was detected in 66% of these patients. The detection frequency was 57.1% in patients with grade 1, 62.5% in patients with grade 2, and 70.4% in patients with grade 3 disease, but this variability did not meet statistical significance. Lower circulating tumor DNA detection was observed in patients who received systemic therapy within six weeks before ctDNA assessment at 43.8% versus 76.5%, and multivariate analysis confirmed this association, demonstrating that recent systemic therapy was associated with an odds ratio of 0.22 versus less recent systemic therapy.  17 patients underwent circulating tumor DNA testing before cytoreductive surgery, and HIPEC and circulating tumor DNA was detected in 23.5% of these cases. No correlation was observed between ctDNA detection and intraoperative PCI index in these patients. Among the 50 patients with ctDNA testing within one year of optimal resection, survival estimates were generated for 36 patients who underwent cytoreductive surgery and HIPEC for grade 2 and 3 appendiceal cancers. The median follow up was 19.6 months. Circulating tumor DNA detection after cytoreductive surgery was associated with a shorter median recurrence free survival of 11.3 months versus not detected in those without ctDNA detection. On multivariate analysis, this was confirmed. The median time interval between surgery and ctDNA detection was 31 weeks. In this cohort of 36 patients, 44.4% or 16 patients developed disease recurrence. During the surveillance period, ctDNA was elevated in 93.8% of these patients, demonstrating a higher sensitivity than CEA, CA 19-9 or CA 125 tumor markers. Only one patient with disease recurrence had negative ctDNA at that time. Among these 16 patients with disease recurrence, one patient with a positive ctDNA test had their first sample drawn after diagnosis of disease recurrence, and one patient who had extensive adjuvant systemic therapy developed ctDNA negative recurrence. In the remaining 14 patients, circulating tumor DNA detection preceded the diagnosis of recurrence on imaging by a median of 11 weeks.   In summary, this study is a large, retrospective report of tumor-informed circulating tumor DNA testing in patients with appendiceal cancers. This study is one of the first to elucidate the factors associated with circulating tumor DNA detection in this disease and a potential role for circulating tumor DNA as an adjunct tool in the surveillance of patients with this malignancy.  Again, I'm Fergus Keane, a JCO Precision Oncology Editorial Fellow. Thank you for listening to the JCO Precision Oncology Article Insight. Please tune in for the next topic. Don't forget to give us a rating or review, and be sure to subscribe so that you never miss an episode. You can find all ASCO shows at www.asco.org/podcasts.    The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

Join Drs. Scott Steele and Dan Scheese as they engage in an in-depth conversation with Dr. Michael Valente about the intricate world of appendiceal masses, including carcinoid, adenocarcinoma, and mucinous neoplasms. Despite the complexity of the subject, this episode skillfully deconstructs the topic through the analysis of three distinct cases, illuminating the latest terminology, diagnostic approaches, and management strategies.  Hosts:  Scott Steele, MD (@ScottRSteeleMD) Dan Scheese, MD (@DanScheese13) Guest: Michael Valente, MD (@DrMikeValente) is an Associate Professor of Surgery at the Cleveland Clinic and Program Director of the colon and rectal residency program. Dr. Valente's specialty and research interests include cancer of the appendix, peritoneum, colon, rectum and anus, cytoreductive surgery/HIPEC, complex re-operative surgery, inflammatory bowel disease, advanced endoscopic techniques, laparoscopic and minimally invasive colorectal surgery, and surgical education. Dr. Valente has published numerous peer-reviewed journal articles and book chapters and has presented his research interests both nationally and internationally. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

During this episode of Making the Rounds, we'll discuss an innovative treatment in abdominal cancers – hyperthermic intraperitoneal chemotherapy, commonly known as HIPEC surgery.   Joining me today on Making the Rounds is Dr. Carrie Luu, a surgical oncologist specializing in abdominal cancers at Banner – University Medicine Tucson and the University of Arizona Cancer Center, and clinical assistant professor with the University of Arizona College of Medicine – Tucson, Department of Surgery in the Division of Surgical Oncology. To learn more about this topic or other oncology related services provided at the University of Arizona Cancer Center, please visit cancercenter.arizona.edu.

During the 2024 Society of Surgical Oncology Annual Meeting (SSO), CancerNetwork® spoke with a variety of surgical oncology experts regarding the topline data they presented. Each conversation also expanded upon how these results can be implemented into the clinical space and the next research steps.  First, Adrienne Bruce Shannon, MD, a complex general surgical oncology fellow at Moffitt Cancer Center, discussed findings from her presentation highlighting responses to neoadjuvant immune checkpoint inhibitors among select patients with mismatch repair deficient (dMMR) gastroesophageal cancer.1  Looking ahead, Shannon described her aim to optimize treatment strategies for this patient population, which may include assessing whether single-agent treatment can be efficacious while avoiding toxicity associated with combination regimens.  Next, Sean Dineen, MD, an associate member in the Gastrointestinal Department, section leader for Peritoneal Disease, and the program director for the Complex General Surgical Oncology Fellowship at Moffitt Cancer Center, spoke about his session, which was aimed at determining appropriate conditions for using cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) for those with colorectal cancer (CRC) and peritoneal metastases.2  Dineen highlighted that there is “good evidence” in support of HIPEC as a “valid treatment option” and emphasized the need to encourage medical oncologists to refer patients for consideration of surgery. Additionally, he spoke about other advancements he hopes to see in this patient population, including the development of markers of various disease volumes that can help identify potential recurrence in those who receive surgery.  Finally, Muhammad Talha Waheed, MD, a research fellow in the Department of Surgical Oncology at City of Hope National Medical Center in Duarte, California, detailed findings from a retrospective analysis indicating disparate treatment access and cancer-related mortality based on racial-economic segregation.3  Specifically, data showed that those who lived in Black and poor majority areas were less likely to receive care that was in accordance with various treatment guidelines while having worse overall survival outcomes. Regarding the next steps, Waheed described his intentions of sharing his findings with policymakers who may create legislature intended to mitigate the disparities observed in the analysis. References 1.        Shannon AB, Mehta RJ, Mok SR, et al. Pathologic response to neoadjuvant immunotherapy in DNA mismatch repair protein-deficient gastroesophageal cancers. Presented at the Society of Surgical Oncology 2024 Annual Meeting; March 20-23, 2024; Atlanta, GA. Abstract 94. 2.        Dineen S. Optimal tumor burden for CRS/HIPEC in colorectal cancer. Presented at the Society of Surgical Oncology 2024 Annual Meeting; March 20-23, 2024; Atlanta, GA. 3.        Waheed MT, Sullivan KM, Haye S, et al. Impact of racialized residential segregation on guideline concordant cancer care and survival. Presented at the Society of Surgical Oncology (SSO) 2024 Annual Meeting; March 20 – 23, 2024; Atlanta, GA; abstract E126.

This week on sMater, Gynaecological Oncologist Dr Nisha Jagasia explains how Mater is using hyperthermic intraperitoneal chemotherapy (HIPEC) to treat tumours, and how the HyNOVA study - which looks at the treatment's efficacy based on the temperature of the chemotherapy drug - is progressing. To learn more about Mater, visit mater.org.au.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Lot Aronson and Willemien van Driel to discuss OVHIPEC1 overall survival analysis. Dr. van Driel is a gynecological oncologist at the Netherlands Cancer Institute since 2004 and has, amongst others, a special interest in determining the role of HIPEC in the treatment of patients with advanced ovarian carcinoma and is PI of the OVHIPEC 1 and OVHIPEC 2 study. Dr. Aronson is a medical doctor currently pursuing a PhD in Gynaecological Oncology at the Netherlands Cancer Institute in Amsterdam. Her research focuses on hyperthermic intraperitoneal chemotherapy (HIPEC) as well as immunotherapy in primary advanced ovarian cancer.    Highlights: The long-term survival analysis of the OVIHPEC-1 study confirms the significant improvement in progression-free and overall survival when adding HIPEC to interval cytoreductive surgery in patients with FIGO stage III ovarian carcinoma for whom primary cytoreduction is not considered feasible due to extensive disease. Neither the number of lines nor the type of subsequent treatment for recurrence differed between the treatment groups. Therefore, the observed improvement in overall survival is unlikely to be attributable a difference in subsequent therapies. Identification of biomarkers (e.g. BRCA/HRD status) to select patients for HIPEC and the combination of HIPEC with PARP inhibitors warrants further investigation.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Rene Pareja, David Viveros-Carreño, and Beatriz Navarro Santana to discuss HIPEC complications. Dr. Viveros-Carreño is a Gynecologic Oncologist at Instituto Nacional de Cancerología, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), and Clínica Universitaria Colombia in Bogotá, Colombia. Dr. Pareja is a gynecologist-oncologist at Astorga Oncology Clinic in Medellín and the National Cancer Institute in Bogotá, Colombia. Dr. Pareja is a reviewer for more than 20 specialty journals, and one of the Associate Editors for IJGC. He is the author of ten book chapters and more than 90 publications in peer-reviewed journals, and at IGCS 2021 he received an award for Community Advancement in Resource-Limited Settings. Dr. Navarro is a gynecologist-oncologist at Insular University hospital in Las Palmas, Spain. She also completed the ESGO fellowship at Institut Bergonie in France   Highlights: The study aimed to assess the complications associated with HIPEC in cytoreductive surgery for epithelial ovarian cancer, examining two distinct time periods (2004–2013 and 2014–2022). This systematic review analyzed 69 studies and including 4928 patients with advanced primary or recurrent epithelial ovarian cancer. No significant differences were observed in complication rates between the two time periods. Overall, complications, including blood transfusions, gastrointestinal, infectious, respiratory, urinary complications, and thromboembolic events, showed no significant change. Rates of ICU admissions, reoperations, and deaths also remained consistent over time. The study concluded that the overall complications associated with HIPEC in ovarian cancer surgery did not decrease, and there was no reduction in the rates of ICU admissions, reoperations, or deaths.

The Evolution of HIPEC in the Treatment of Cancer with guest Dr. Kiran Turaga December 24, 2023

El Dr. Luis Alfonso Romero, oncólogo médico de León, Guanajuato, México, en este episodio de “Pase de visita” abordará un caso clínico de una paciente con cáncer de ovario seroso de alto grado. Como invitados al programa se encuentran tres médicos mexicanos, el Dr. Eduardo Cisneros, oncólogo quirúrgico residente en el Hospital Juárez de México; la Dra. Gabriela Castro, ginecooncóloga residente en el Hospital Militar de Especialidades de la Mujer, SEDENA y el Dr. Alfonso Torres Rojo, cirujano oncólogo adscrito al Hospital Ángeles México, los tres de la Ciudad de México. Ellos, con base en evidencia científica y en su experiencia, responderán a varias interrogantes. El caso describe a una mujer de 58 años que recibió el diagnóstico de cáncer de ovario seroso de alto grado en etapa III hace tres años. En ese momento, se le administró un tratamiento que incluyó citorreducción primaria R0, seguida de seis ciclos de quimioterapia con carboplatino y paclitaxel. Después de tres años sin evidencia de enfermedad, la paciente experimenta una recurrencia, evidenciada por un aumento en los niveles de Ca125 hasta 200 y por tomografía se revela una actividad tumoral de 4 cm a nivel pélvico que parece afectar el sigmoides. Las preguntas para los médicos respecto a este caso son las siguientes: ¿Cuál es el beneficio de realizar la citorreducción antes de iniciar la quimioterapia sistémica en casos de recurrencias locales? ¿Se ha evidenciado algún beneficio al combinar la cirugía con quimioterapia hipertérmica intrabdominal (Hipec) en este contexto? ¿Qué seguridad se le ofrece a la paciente con la resección multiorgánica en términos de control de la enfermedad? Fecha de grabación: 6, 12 y 17 de octubre de 2023.     Todos los comentarios emitidos por los participantes son a título personal y no reflejan la opinión de ScienceLink u otros. Se deberá revisar las indicaciones aprobadas en el país para cada uno de los tratamientos y medicamentos comentados. Las opiniones vertidas en este programa son responsabilidad de los participantes o entrevistados, ScienceLink las ha incluido con fines educativos. Este material está dirigido a profesionales de la salud exclusivamente.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Jean-Marc Classe to discuss the CHIPOR Trial. Dr. Classe is a surgeon and former head of the surgical department of the Institute of Surgical Oncology of Nantes, France. He is a professor in oncology and president of the French Society of Surgical Oncology.   Highlights: The CHIPOR phase III RCT studied the use of HIPEC in 1st PSROC who underwent complete cytoreductive op after 2nd-line platinum-based chemo. Randomization was performed during complete cytoreductive surgery. The primary endpoint was OS. Results showed HIPEC significantly improved OS, HR 0.69, p=0.020. This study suggests that HIPEC can be a beneficial addition to the tx strategy for women with 1st PSROC when used in conjunction with 2nd-line platinum-based chemo and complete cytoreductive surgery.

In unserer neuen Folge sprechen wir über die Rolle der palliativen Metallstenteinlage bei malignen rektalen Obstruktionen. Prof. Hünerbein hat dazu mit Kollegen der Robert-Rössle Klinik im Jahre 2005 eine retrospektive Analyse durchgeführt. Außerdem thematisieren wir die HIPEC und das Tumordebulking. Wie startet man, wenn man Peritonealkarzinosezentrum werden möchte? Hünerbein M, Krause M, Moesta KT, Rau B, Schlag PM. Palliation of malignant rectal obstruction with self-expanding metal stents. Surgery. 2005 Jan;137(1):42-7. doi: 10.1016/j.surg.2004.05.043. PMID: 15614280.

Wir thematisieren mal wieder die HIPEC. Es geht um eine randomisierte Studie, in welcher der Einfluss unterschiedlicher intrabdomineller Drücke auf die Gewebeverteilung und Pharmakokinetik von Cisplatin untersucht wurde. Coole Studie aus Italien! Zudem sprechen wir über die Probleme und Notwendigkeiten beim Aufbau eines Peritonealkarzinosezentrums. Kusamura S, Azmi N, Fumagalli L, Baratti D, Guaglio M, Cavalleri A, Garrone G, Battaglia L, Barretta F, Deraco M. Phase II randomized study on tissue distribution and pharmacokinetics of cisplatin according to different levels of intra-abdominal pressure (IAP) during HIPEC (NCT02949791). Eur J Surg Oncol. 2021 Jan;47(1):82-88. doi: 10.1016/j.ejso.2019.06.022. Epub 2019 Jun 21. PMID: 31262599.

In this heartfelt and inspiring episode on the Canadian Podcast, Zak had the opportunity to speak with an incredible soul, a Calgary Firefighter whose name is Lorne Miller. Lorne battled liposarcoma, a rare form of cancer. Diagnosed in May 2021, Lorne faced months of treatments and a triumphant celebration of one year cancer-free in June 2022, only to be met with the devastating news of a recurrence just a few months later. Witness Lorne's unwavering determination and resilience as he confronts the fear of recurrence head-on. With the unwavering support of his loving wife, Lindsay, and his caring medical team at the Tom Baker Cancer Centre, Lorne takes us through the ups and downs of his second round of treatments, culminating in a critical surgery on December 12th. Amidst the challenges, Lorne sets a powerful goal—to be home for his daughter Esmae's 7th birthday on Christmas Eve. Experience the emotions as Lorne's surgery is successful, and he receives HIPEC treatment to eliminate any remaining cancer cells. Thanks to the tremendous support of his community, Lorne is reunited with his family just in time for the special day. Through his personal journey, Lorne acknowledges the profound impact of his support system, both at home and at work. His fellow firefighters, who became his second family, stood by his side, offering unwavering care and encouragement throughout the cancer journey. Now, Lorne aims to give back and create more cherished moments for cancer patients like himself by supporting the Alberta Cancer Foundation. Every donation can make a difference, providing more invaluable moments for patients to spend with their loved ones. Join us in this heartwarming tale of hope, love, and community strength. Subscribe to our channel to follow more stories like Lorne's journey and learn, share and grow from each other.

William S. Laird gives readers an enlightening, inspiring and unflinching look at his journey with appendiceal cancer in the memoir “Not Me, Cancer,” now available via Archway Publishing. “I wrote this book when I was on chemo,” Laird tells CURE. “And I told my wife one day, I said, ‘I'm gonna write a book about this experience.' And of course, I got a pump on my side, and she's looking at me like I'm a little bit crazy, because I'm not an author. And she was kind of like ‘Oh well,' or not kind of believing it. “But two weeks later, I started typing and I journaled my story, and not my whole story but I took it to a point where I felt I made my points. And I felt like God tapped me on the shoulder to write this book. He helped me write it. And I think there's good messaging in it.” Laird first received a diagnosis of appendiceal cancer in 2015. In the nearly decade since, he has undergone 35 rounds of chemotherapy and counting as well as procedures including a surgical debulking via HIPEC (hyperthermic intraperitoneal chemotherapy) — or, as he puts it: “Basically you're cut open, pelvis to sternum, and they take all your insides out, and if there's anything in there they don't like they take it out, and they kind of put you back together and run 107 degree chemo therapy through your abdomen for an hour and a half with nurses pushing on your abdomen to get it in every crack and crevice.” In this episode of the “Cancer Horizons” podcast, Laird speaks with CURE about his decision to share his story, his cancer journey so far and the importance of perseverance. “Now, it's a rare cancer, I don't know if it ever goes away, I'm gonna try to outfight it,” he said. “But I never look at the situation like this is the end of me. I don't. It's just (that) this is a bump in the road, it's supposed to be part of my life, and I deal with it. “I'll get chemo, sometimes I'll be at work the next day. And people see I really push. And so I don't do things traditionally. And I even see it when people find out I've got cancer, they are ‘Oh, no,' like, ‘Oh, that's the end,' but to me, it isn't. It's just part of my life, and I'm a fighter.” Early in “Not Me, Cancer,” Laird makes a clear case for sharing his story of survivorship, writing that “all of what we know and experience from others can have a personal impact on each of us if we are faced with the same cancer challenges.” “I'm a human, I care about my fellow humans,” he tells CURE, “and if I can have an impact on this planet, and make a difference for people, which I believe I can, then I feel like I'm kind of gifted a little bit. … If by my example I can help others, to me, that's the most important thing that I can do in my lifetime.” For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

Our experts dive into an unusual form of chemotherapy called hyperthermic intraperitoneal chemotherapy – or HIPEC – where drugs are administered through the belly. Guests include Dr. Mazin Al-Kasspooles.

Drs Gushchin and Diaz-Montes discuss findings from the HOT trial evaluating health-related QOL outcomes after cytoreductive surgery and HIPEC in patients with primary ovarian cancer, the importance of devising more accurate strategies to assess patient QOL after receiving cytoreduction and HIPEC, and future directions for this research.

Rick Greene, MD, discusses with Joel Baumgartner, MD, the rate of occult omental metastases in patients undergoing cytoreductive surgery-HIPEC for peritoneal surface malignancy. Dr. Baumgartner is author of, “Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC?” Dr. Baumgartner is Associate Professor in the Department of Surgery, UC San Diego School of Medicine, San Diego, CA. http://doi.org/10.1245/S10434-022-12714-7

This week we sit down with Oliver Eng, MD, FACS, FSSO to discuss heated intraperitoneal chemotherapy (HIPEC). Dr. Eng is a surgical oncologist and an Associate Professor in the Division of Surgical Oncology at the University of California, Irvine, where he is also Associate Director of the Peritoneal Surface Malignancy Program as well as the Complex General Surgical Oncology Fellowship. He is a double board-certified surgeon and surgical oncologist who specializes in the treatment of cancers in the abdomen, particularly cancers that have spread to the peritoneum, the membrane that lines the abdominal cavity. He specializes in complex cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC). Dr. Eng has co-authored numerous peer-reviewed manuscripts in journals including Cancer Discovery, Journal of Clinical Oncology, Cancer, and British Journal of Cancer. He has received numerous teaching and research awards and was most recently a recipient of The Lynx Group's 40 Under 40 in Cancer Award, which recognizes the contributions being made across the field of cancer by emerging leaders nationally.

In this JCO Precision Oncology Conversations podcast, JCO PO author Dr. Thanh Dellinger of City of Hope National Medical Center shares insights into the research published in her article, “Hyperthermic Intraperitoneal Chemotherapy–Induced Molecular Changes in Humans Validate Preclinical Data in Ovarian Cancer.” Podcast host Dr. Abdul Rafeh Naqash talks with Dr. Dellinger about hyperthermic intraperitoneal chemotherapy (HIPEC) and the various challenges of the treatment of epithelial ovarian cancer (EOC). The study described in this JCO PO article discusses protein expression, RNAseq alterations and signature, and whole-transcriptome sequencing and signatures. Read here  https://ascopubs.org/doi/full/10.1200/PO.21.00239   TRANSCRIPT Dr. Abdul Rafeh Naqash: Welcome to ASCO's Precision Oncology Conversations where we bring you the highlights and overview of precision oncology. This podcast is here to provide interactive dialogue focusing on the excellent research published in the JCO Precision Oncology. Our episodes will feature engaging conversations regarding precision oncology with the authors of a clinically relevant and highly significant JCO Precision Oncology article. You can find all our shows including this one at asco.org/podcasts, or wherever you get your podcasts. Hello, I am Dr. Abdul Rafeh Naqash. I'm a medical oncologist and a phase one clinical trialist at the OU Stephenson Cancer Center. You're listening to JCO Precision Oncology Conversations. I have no conflicts of interest related to this podcast. A complete list of disclosures is available at the end of each episode. Today, I will be talking with Dr. Thanh Dellinger from the City of Hope Comprehensive Cancer Center, who's a gynecological oncologist, and we'll be talking about her JCO Precision Oncology article, ‘Hyperthermic Intraperitoneal Chemotherapy-Induced Molecular Changes in Humans Validate Preclinical Data in Ovarian Cancer.' Dr. Dellinger does not have any conflicts of interest. Hi, Dr. Dellinger, welcome to our podcast! Dr. Thanh Dellinger: Hi, Dr. Naqash! It's such a pleasure to be on with you. Dr. Abdul Rafeh Naqash: We recently saw your paper published. It's one of those interesting, clinical translational papers that we felt needed to be highlighted in our Precision Oncology Podcast series. So, we're really excited to have you here today to take a deeper dive into the findings and some of the novel approaches that you used in your recent publication. So, for starters, could you give our listeners a brief idea of what HIPEC is, where it's used, and when it's used in ovarian cancer? Dr. Thanh Dellinger: Right! Thank you very much for this great introduction. So, HIPEC or Hyperthermic Intraperitoneal Chemotherapy has been used in ovarian cancer for quite some time. The most relevant data giving us an indication for ovarian cancer was published by Dr. van Driel in the OVHIPEC-1 randomized trial several years ago in the New England Journal of Medicine, which demonstrated that in stage 3 ovarian cancer patients who undergo an interval tumor debulking with HIPEC, that those patients appear to enjoy both progression-free and overall survival benefit. In fact, the overall survival benefit is nearly 12 months for those patients. So, with this in mind and a number of other data, the HIPEC treatment for those patients that interval debulking has been incorporated into the NCCN guidelines. Nonetheless, there have been some criticisms of HIPEC and it still remains to be seen who those patients are, the ovarian cancer patients who really best benefit from HIPEC, given the morbidity of HIPEC. We now know also that HIPEC is probably equivalent to just cytoreductive surgery alone in terms of morbidity. Dr. Abdul Rafeh Naqash: Thank you for that explanation. And especially for people like myself, who are not surgeons or gynecological oncologists, that was very helpful. So, my next question, and you probably partly answered it, but I'm going to still ask the question is: what is the reason you think that intraperitoneal chemotherapy overall, has not been as widely adopted? Dr. Thanh Dellinger: You touch on a very good point there. As many of the listeners may understand, IP chemotherapy has demonstrated a lot of efficacies in multiple clinical trials over the last decade or two decades even. And part of why, despite its benefit, it has not been taken up in the overall community may really be the difficulty and the complexity of doing IP chemotherapy in the community, especially the side effects are difficult sometimes to take care of. There's increased abdominal pain and there are catheter issues. And so, especially with more recent data, that with the presence of Avastin, IP chemotherapy may not necessarily be as beneficial. Unfortunately, IP chemotherapy hasn't been really taken up in daily oncologic care with ovarian cancer. Nonetheless, we know that there are a lot of theoretical benefits because of the peritoneal metastasis not being as best treated with intravenous chemotherapy as with regional therapy. Dr. Abdul Rafeh Naqash: Thank you! So, now going to the data that you published. I was very intrigued with some of the findings. And from what I understood, your main aim was to understand predictive biomarkers to identify patients or basically identify molecular characteristics for patients' selection for HIPEC. So, could you tell us more about why you initiated this study? And I understand this is one of the, I believe the first study in humans to evaluate some of these interesting biomarkers, both pre- and post-. So, what was the background of doing this trial? And what led to this interesting study? Dr. Thanh Dellinger: Thank you for pointing out this aim. There's a lot of criticism of HIPEC and part of it is that we may not exactly understand the mechanisms of HIPEC, why is it that it works so well in some patients? There's a lot of preclinical data supporting hyperthermia, especially with cisplatin. There's synergy between cisplatin and hyperthermia, and improving the DNA adduct formation. There's increased cytotoxicity seen when the temperature increases up to 43 degrees. And there's also a T-cell activation and immune response that occurs during hyperthermia. So, a lot of this, however, has been done in preclinical studies, in vitro data as well as preclinical mouse models. There hasn't been much or really anything published that, as far as I know, has been done in humans. And so, this particular study looked at both pre-treatments, pre-HIPEC specimens, peritoneal biopsies, as well as immediate post-operative peritoneal biopsies, tumors, and normal samples, and we wanted to look both at the whole transcriptomic sequencing profile, but also at the tumor microenvironment. Dr. Abdul Rafeh Naqash: From a logistic standpoint, from a trial design standpoint, was this a phase 1 study? I know you use the term pilot in the publication. So, were you trying to look at safety also, or was this primarily I would say, a biomarker, pharmacodynamic biomarker-driven study that you were trying to evaluate? Dr. Thanh Dellinger: You're correct. This was essentially a feasibility study. But we additionally looked at safety and feasibility with HIPEC at our institution. And in some respects, we also looked at the feasibility of giving intraperitoneal chemotherapy normothermically early after HIPEC, and so it was also an endpoint to look at safety. Dr. Abdul Rafeh Naqash: Understand! I believe there was some difference in the dose for the cisplatin, I believe, is the chemotherapy that you use. What was the rationale for the difference in the dose for 75 milligrams per meter square that you use in your study? Dr. Thanh Dellinger: The study was initiated at a time before the OVHIPEC-1 trial was published. And so, at that time, the HIPEC dose for cisplatin was still not established. 75 milligrams per meter square for cisplatin was actually used in other trials, and has been noted to be effective in other clinical trials. Dr. Abdul Rafeh Naqash: Thank you! Now going to the patient population for this trial. What type of patients were you enrolling? Was it just epithelial ovarian cancer patients, did these patients need to have peritoneal metastases when you were doing this cytoreductive surgery? What was the patient population that you were targeting in this trial? Dr. Thanh Dellinger: The majority of the patients did have epithelial ovarian cancer. We did enroll a few, actually 5, uterine cancer patients as well, which were not included in this specific publication. But the majority of them were epithelial ovarian cancer patients. Dr. Abdul Rafeh Naqash: Going to the interesting translational analysis. So, you had three subsets of patients based on the biopsy collection. What were your hypotheses, and what drove some of those translational studies to understand the biomarkers? Dr. Thanh Dellinger: The first translational analysis we conducted was the whole transcriptomic sequencing, and specifically, we wanted to look, one, for any potential transcriptomic signatures that may correlate with survival or improved response to HIPEC. The second one was to look at whole exome sequencing. Thirdly, we looked at whole transcriptomic sequencing differences before and after HIPEC treatment. And lastly, we looked at the tumor microenvironment through multiplexing of certain markers associated with T-cell response. Dr. Abdul Rafeh Naqash: From a clinical outcome standpoint - and we'll discuss the biomarkers in more detail - from a clinical standpoint, when I briefly looked over the PFS curves, were the results, as far as expected outcomes, were they similar to what you see with the current standard? Or were there any unusual safety signals? Or would you attribute any of the adverse events that you saw to intraperitoneal chemotherapy specifically? Because I believe some patients did have some chemotherapy pre-surgery, neoadjuvant if I'm correct. So, how would you attribute some of those AEs, and if at all, did you see any interesting safety signals of concern and outcomes as far as PFS is concerned? Dr. Thanh Dellinger: So, one of the major toxicities that we saw in the first half of our trial were actually renal toxicities. In fact, there were actually two patients who could not go on to adjuvant chemotherapy because they suffered chronic renal failure. And because of that, halfway through the trial, we did actually add a nephro protectant called sodium thiosulfate. And this actually dramatically improved those renal toxicities. And for the second half of our study, no patients suffered grade three or grade four renal adverse events. And so, that did change significantly. Dr. Abdul Rafeh Naqash: From a genomic standpoint, it's very interesting that you were able to do all these very cool and interesting translational biomarker studies, including multiplex immunofluorescence. From a genomic standpoint, though, would you say it's fair to say that there was no significant correlation based on the baseline genomics for some of the patients and their outcomes? Is that a fair assessment? Dr. Thanh Dellinger: Yes, that is a very fair assessment. I think that our cohort was really too small to make those kinds of assessments. I don't know whether you saw there recently was a paper published by the OVHIPEC-1 group looking at their cohort of over 200 patients that underwent the interval cytoreductive surgery in HIPEC and they did actually demonstrate benefit in patients who are HIV-positive but BRCA wild-type, but not necessarily in BRCA mutated patients. So, I think that I would point to that study to look for genomic effects with HIPEC patients. Dr. Abdul Rafeh Naqash: Understand. Now, again, going to the biomarkers that your team evaluated, it seems from among good responders especially, you saw an increase in tumor necrosis factor, alpha signaling, NF-kappa B signaling, KRAS signaling, and then you also saw some pathways that were downregulated, especially the G2-M checkpoint, and Myc targets. What would you say the correlation of these is in terms of future drug development in this specific setting? Dr. Thanh Dellinger: I think that we did see some increase in immune pathways in patients who did better in the end. And also, our multiplex results did demonstrate that E1 expression was increased in patients who had better responses after HIPEC. So, our hypothesis is that potentially, there's an activation of T-cell response with HIPEC and that potentially PD-1 inhibitor could be added in the future. This is a hypothesis that certainly would need to have more work, but it's something that is interesting enough to really look at in ways of how to improve HIPEC. Dr. Abdul Rafeh Naqash: Going to your point on the PD-1, I found really intriguing that you were able to see an increase in PD-1 expression on CD8+ T cells but no actual increase in the number of CD8+ T cells suggesting there's some sort of activation of this marker and this may not necessarily be a marker for T-cell exhaustion. So, would you interpret it in a way that in a different setting, perhaps a new adjuvant approach with immunotherapy, would perhaps somehow augment this and then you could see more upregulation? Is there any work being done in that field? How would you put this in the context of your findings? Dr. Thanh Dellinger: You bring up a really great point because to date HIPEC has been demonstrated to have benefit in the interval setting. But there was a more recent study done by, well not recent, a more recently published study by a Korean group that demonstrated no benefit in the adjuvant setting for HIPEC and still some benefit in the interval setting. And the question is, are these really two different types of cohorts who respond differently because of potential differences in immune response and tumor microenvironment? I think that that would be a great way of delving further into this. What are really the differences in tumor microenvironment changes in those two different settings? Dr. Abdul Rafeh Naqash: Definitely! It's very exciting. You've also shown upregulation of, as you mentioned earlier, immune pathways, as well as upregulation of genes related to heat shock proteins. Does that play into future drug development as far as HSP Inhibitors are concerned? Dr. Thanh Dellinger: That is a really great question. Certainly, in preclinical models, heat shock proteins are known to be elevated and they do activate dendritic cells and result in T-cell activation. Now, whether that can be spelled out into actually some future drug therapy definitely remains to be seen. To date, there hasn't been any success in using heat shock types of agents or inhibitors, unfortunately. So, I think while this is of great interest, I'm not entirely sure that this will translate into any drug therapy in the future. Dr. Abdul Rafeh Naqash: And I totally connect with you there as a phase 1 trialist. I completely agree that we see a lot of translational data, more often than not, going into the phase 1 site because many of these targets are not actionable. Now, from a DNA repair standpoint, you did see that there was interference with DNA repair, as far as some of the analyses that you did, but I did not specifically see any markers for DNA damage that were assessed on the biopsies such as Gamma-H2AX, RAD 51, or Phospho-NBS. Was there a reason why that was not looked at? Dr. Thanh Dellinger: I think that we did look at that and there weren't really any significant results. We did put some of the data into the supplementary data. I think that in the end, our cohort was really too small to really make any meaningful data. But I absolutely agree with you looking at HSP and DNA repair is really important. And as I mentioned that most recently published paper does address that. Dr. Abdul Rafeh Naqash: Excellent! Do you think that there could be any confounders in this analysis that could have led to the upregulation of some of these pathways and may not necessarily have been the intraperitoneal chemotherapy? Could you think of some other reasons that this could have been a confounding factor? Or would it primarily be attributed to the intraperitoneal chemotherapy that you guys have looked at in this interesting paper? Dr. Thanh Dellinger: Yeah, it is a rather small cohort. So, I think that more data is required to potentially repeat this in the larger cohort. But what is interesting is that we did have paired analysis. So, we had matched peritoneal samples from the same patients looking before the HIPEC and after the HIPEC, which is very unique and hasn't really been done in the setting before. And while you couldn't necessarily repeat the same exact peritoneal tumor it was very close. And so, in the best setting, I think that we did have a good paired analysis. Dr. Abdul Rafeh Naqash: That was one of the very interesting aspects of this study that I very much appreciated, that you were able to get some of those paired biopsies and do the analyses on samples and look at all these markers. So, this was all excellent work and definitely intrigues the mind into what other ways one could use some of these findings to develop future combination-based approaches, whether it's the neoadjuvant or the adjuvant setting for patients with ovarian cancer. Are there any next steps as part of this project that you are excited about that you can share? Dr. Thanh Dellinger: Right! I'm definitely very excited about trying to build on this and essentially developing a much larger predictive study using hundreds of ovarian cancer HIPEC-treated tumors in collaboration with others. We have definitely developed a great community of HIPEC investigators who are very interested in developing somewhat of a predictive signature for ovarian cancer undergoing HIPEC. So, I'm very excited to hopefully be able to develop this consortium of HIPEC transcriptomic research. And so, I'm looking forward to collaborating with my co-investigators on that. Dr. Abdul Rafeh Naqash: It was definitely exciting to talk to you about your work. Now, I want to ask you about you as an investigator or as a researcher. How did you end up in this field? What was your background while you were pursuing science and medicine? How did you end up in this field and how are you mentoring the next generation? Dr. Thanh Dellinger: When I was a fellow at UCI, my mentor Robert Bristow introduced me to HIPEC and that has really stuck. As a GYN oncologist, it is hard to really do both chemo and be a good surgeon. And in many ways, I have really specialized in surgical oncology more than in medical oncology. And HIPEC is really a very nice blend of the two. It allows you to do clinical trials while still doing surgery and giving some chemotherapy. Really, it was for the introduction of my more recent mentor, Elena Rodriguez, who really introduced me to genomics and applying this to HIPEC samples that this all came about. And so, I think that there are a lot of opportunities for surgical oncologists who do not give chemo and may think that clinical research is not for them, but there are a lot of translational opportunities and clinical trial opportunities for those who don't give chemotherapy, but are surgical oncologists. Dr. Abdul Rafeh Naqash: Thank you so much. We are really excited for all the work that you're doing and will continue to do and hopefully, we'll see more of this evolve as time progresses. Dr. Thanh Dellinger: Thank you so much, Dr. Naqash. It was such a pleasure meeting you and talking to you. Dr. Abdul Rafeh Naqash: Same here. Thank you for listening to JCO Precision Oncology Conversations. To listen to more, visit asco.org/podcasts, or find them on Google Play Spotify and Apple podcasts. To stay up to date, be sure to follow and share JCO Precision Oncology content on Twitter. The Twitter handle is @JCOPO_ASCO. All JCO PO articles and series can be found at ascopubs.org/journals/PO. The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.  Guest Bio Dr. Thanh Dellinger, MD, is a gynecologic oncologist and physician-scientist who specializes in ovarian and uterine cancer. She is an expert in hyperthermic (HIPEC) and pressurized aerosolized intraperitoneal chemotherapy (PIPAC), and is the primary investigator of clinical and translational studies focusing on these therapies. She received her medical degree at University of California Irvine, where she also completed a gynecologic oncology fellowship. She is leading the first U.S. clinical trial in PIPAC (pressurized intraperitoneal aerosolized chemotherapy), a novel therapy using pressurized aerosolized chemotherapy for ovarian cancer. Her current research focuses on innovative therapies for ovarian cancer using intraoperative chemotherapy, and novel antibody and nanoparticle therapies.

Hyperthermic intraperitoneal chemotherapy (HIPEC) delivers chemotherapy directly into the abdominal cavity. It is used in conjunction with cancer surgery for people with advanced cancer that has spread inside the abdomen. “Hyperthermic” means warm or hot. “Intraperitoneal” means inside the abdominal cavity, which is encased in a sac called the peritoneum. HIPEC uses high-dose chemotherapy to kill microscopic cancer cells inside the abdominal cavity. The HIPEC procedure is performed immediately after a surgeon has removed all visible cancer in the abdomen. HIPEC is well studied in several types of cancer and being explored as a potential treatment in others. "So really any cancer that's just localized in the abdomen on the surface of the peritoneum could be a candidate," explains Dr. Travis Grotz, a Mayo Clinic surgical oncologist. "We know for sure, based on studies and data that HIPEC works well for cancers of the colon, cancers of the appendix, cancer to the ovaries, cancer of the stomach, and there's even a cancer of the lining of the peritoneum, called mesothelioma. So those would be the cancers I think that are well studied and well accepted. Then, there are more rare tumors that we have less data for, such as cancer to the pancreas or gallbladder or small intestine, that we don't know yet if that's the right treatment."The specific type of chemotherapy used for HIPEC varies depending on the type of cancer being treated. The abdominal cavity is bathed with hot chemotherapy to kill any microscopic cancer cells that might still be present. Heating the chemotherapy enhances its effectiveness because, when it's hot, chemotherapy penetrates the tissue more deeply, increasing the number of cancer cells it can reach.On this Mayo Clinic Q&A podcast, Dr. Grotz explains what HIPEC is, how it is performed, and the risks and benefits of the treatment.Related Articles: "New therapies bring hope for ovarian cancer." "Alternative chemotherapy offers hope for late-stage cancers." "Aggressive treatment turns tide in fighting colon cancer."

An interview with Dr. Van Morris from The University of Texas MD Anderson Cancer Center in Houston, TX and Dr. Cathy Eng from Vanderbilt-Ingram Cancer Center in Nashville, TN, co-chairs on "Treatment of Metastatic Colorectal Cancer: ASCO Guideline." Dr. Morris and Dr. Eng review the evidence-based recommendations from the guideline, focusing on areas of uncertainty in the treatment of metastatic colorectal cancer, and highlighting the importance of multidisciplinary collaboration and shared decision-making between patients and clinicians. Read the full guideline at www.asco.org/gastrointestinal-cancer-guidelines.   TRANSCRIPT Brittany Harvey: Hello, and welcome to the ASCO Guidelines Podcast series, brought to you by the ASCO Podcast Network; a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at: asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Van Morris, from The University of Texas MD Anderson Cancer Center in Houston, Texas, and Dr. Cathy Eng from Vanderbilt-Ingram Cancer Center in Nashville, Tennessee - co-chairs on, 'Treatment of Metastatic Colorectal Cancer, ASCO Guideline.' Thank you for being here, Dr. Morris, and Dr. Eng. Dr. Cathy Eng: Thank you. Dr. Van Morris: Thank you. Brittany Harvey: First. I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest policy is followed for each guideline. The full Conflict of Interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Morris, do you have any relevant disclosures that are directly related to the guideline topic? Dr. Van Morris: Not personally, but I do have research support to my institution from Pfizer and Bristol Myers Squibb who have products that I'll be discussing on this podcast. Brittany Harvey: Thank you, Dr. Morris. And Dr. Eng, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Cathy Eng: Also, not personally associated with any honorarium specific to this topic. Brittany Harvey: Great. Thank you both. So then, let's talk about the content of this guideline. So first, Dr. Morris, can you provide an overview of the scope of this guideline? Dr. Van Morris: Sure. So colorectal cancer is the second-leading cause of cancer-related death in the United States. And especially in the time of the recent COVID-19 pandemic with people less likely to go for screening colonoscopies, there's great concern that more and more patients will be presenting at the time of their initial diagnosis with later-stage, more advanced colorectal cancer. So with that said, research is moving very quickly for the benefit of patients with colorectal cancer, and we were interested in assembling a multidisciplinary team that consisted of medical oncologists, surgical oncologists, radiation oncologists, pathologists, and radiologists as well, to help us make guidelines that really summarize the most relevant up-to-date practices, based on rigorous literature review for treatment recommendations for advanced metastatic colorectal cancer. Brittany Harvey: Great. And then as you just mentioned, this guideline provides recommendations, and a lot of those focus on areas of uncertainty in the treatment of metastatic colorectal cancer. And I'd like to review those key recommendations that you mentioned for our listeners. So, Dr. Eng, starting with - for patients with previously untreated, initially unresectable metastatic colorectal cancer, who are candidates for chemotherapy plus bevacizumab, is doublet or triplet cytotoxic chemotherapy recommended? Dr. Cathy Eng: For treatment-naive patients, bevacizumab has been approved, and we do agree that it's a very reasonable treatment option with doublet or triplet therapy for our patient population. Obviously, these are guidelines, and it's extremely important to keep in mind that as a provider, you need to discuss the potential side effects with the patient. With bevacizumab, you know, standard concerns must be discussed with the patient, especially in regards to wound healing, if they've had recent surgery or any potential risk factors for a recent cardiac event from a recent thrombosis. So, those things obviously, would preclude the patient from initiating treatment with bevacizumab. But currently, doublet therapy or triplet therapy could be a potential option for patients. Brittany Harvey: Great. And yes, as you mentioned, shared decision-making is paramount to these decisions. So then following that recommendation, Dr. Morris, which patients should be offered pembrolizumab in the first-line setting? Dr. Van Morris: Yeah. So, I think that this represents really one of the exciting advances in the treatment of metastatic colorectal cancer over the past several years. We have great data now that suggests for patients with microsatellite instability-high metastatic colorectal cancer, especially who have not had any prior treatment, we would recommend use of immune checkpoint blockade therapies, really coming from the seminal KEYNOTE-177 trial. This was a phase III international trial that looked at patients with advanced unresectable or metastatic colorectal cancer. And patients were either randomized to pembrolizumab monotherapy, or cytotoxic chemotherapy with FOLFOX, with or without bevacizumab. And this trial did meet its primary endpoint and showed an improvement in progression-free survival, with use of pembrolizumab as a single agent relative to cytotoxic chemotherapy. And based on this trial and the clear benefit that we see in patients with pembrolizumab, the FDA has approved this as an option for patients with MSI-high untreated metastatic colorectal cancer. There are other trials which have looked at use of immunotherapy; the CheckMate 142 trial looked at combination PD-1 CTLA-4 therapy as a single-arm study. And, you know, there's another trial, the CheckMate 8HW, which is looking at one versus two immunotherapy agents in this setting as well. But really, as it stands for now, patients with MSI-high untreated metastatic colorectal cancer are the ones who benefit from the use of immunotherapy. One of the questions that we often get in talking with other clinical oncologists is the FDA approval for pembrolizumab in any cancer type for a TMB, tumor mutation burden, greater than 10. And, we talked about this with our panel in this context, and we don't see that patients with microsatellite-stable metastatic colorectal cancer, who have a tumor mutation burden over 10 benefit from use of immunotherapy. There is one exception to this for patients who harbor pathogenic POLE or POLD1 mutations, these patients oftentimes do experience sustained clinical benefit with immunotherapy. But in general, patients with microsatellite-stable metastatic colorectal cancer, who don't have POLE/POLD1 mutations, we don't favor use of immunotherapy in that context at this point in time. Brittany Harvey: Great. Thank you for reviewing that recommendation and the data behind who benefits and who doesn't benefit from immunotherapy in this setting. So then following that, the next question that this guideline addressed is for treatment-naive RAS-wild type metastatic colorectal cancer. So, for these patients, Dr. Eng, is anti-EGFR therapy recommended for patients with right or left sided primary tumors? Dr. Cathy Eng: That is such an important question, and thank you for asking this. We know based upon pivotal data from CALGB/SWOG 80405, that right-sided tumors treatment-naive, even if they're RAS-wild type, these patients should not receive anti-EGFR therapy. But also, we've learned from 80405, FIRE-3, and PEAK, which was a phase two study, that there appeared to be some benefit versus anti-VEGF therapy for left-sided tumors based upon studies that have been conducted. So, at this year's ASCO, actually, the PARADIGM trial was specifically a phase III trial, more focused on left-sided tumors. It was amended twice before it decided to focus on the left-sided patient population. And it was a phase III study where patients were randomized to FOLFOX plus panitumumab versus FOLFOX and bevacizumab. And the primary endpoint was overall survival. And we added this data to our guidelines. This data just came out, hot off the presses in June, at this year's ASCO. And the primary endpoint was fulfilled. And basically, it prospectively demonstrated that the data from the other three trials, based upon a pooled analysis, suggested left-sided tumors fare better with anti-EGFR therapy. And in fact, the PARADIGM trial basically validated those findings. Obviously, the PARADIGM trial just recently presented, we have not seen the final publication, we do not know much about the maintenance setting, but specifically, when thinking about anti-EGFR therapy, it is very reasonable to consider it in a left-sided tumor, all RAS-wild type patient population. I would like to mention though, and we do highlight this also in the guidelines, which is critically important, is that there was another study, which is a phase III trial called, TRIPLETE, that was presented as well, looking at FOLFOXIRI plus panitumumab versus basically, standard treatment. And what it noted is that there is no additional benefit for FOLFOXIRI plus panitumumab in left-sided tumors in regards to response or progression-free survival, there was no additional benefit. So, FOLFOX plus panitumumab seems very reasonable, FOLFOXIRI plus panitumumab is not necessarily needed in left-sided tumors. Brittany Harvey: Great. Thank you for that explanation, and also for the work of the panel to rapidly include this new information recently presented at ASCO. So then following those recommendations, Dr. Morris, what recommendation did the panel make for patients with previously-treated metastatic colorectal cancer with a BRAF V600E mutation? Dr. Van Morris: Yeah. So, this recommendation was made essentially based on one randomized phase III clinical trial, which reported out about three years ago now, the BEACON trial. This is looking at patients with BRAF V600E mutated metastatic colorectal cancer, which we know accounts for probably eight to 10% of all patients with advanced colorectal cancer, and when found, really harbors a poor prognosis relative to BRAF-wild type counterparts. So, the BEACON trial was a trial that looked at patients with previously-treated metastatic colorectal cancer, who have BRAF mutations, either kind of standard of care cytotoxic chemotherapy, or a BRAF/EGFR combination with encorafenib and cetuximab or alternatively, a BRAF/EGFR/MEK combination. That trial showed that improvement in survival outcomes with a BRAF/EGFR-targeted approach, as well as the BRAF/MEK/EGFR. However, because there was no difference in survival with the addition of the MEK inhibitor, the FDA subsequently approved encorafenib and cetuximab as the recommended treatment for patients with BRAF V600E previously-treated metastatic colorectal cancer. Because the MEK combination with binimetinib was not recommended by the FDA, you know, we did not include that analysis in our guidelines for ASCO. But as it stands right now, we do strongly encourage all clinicians to check for their BRAF V600E mutation status in their patients with metastatic colorectal cancer, with the goal of getting them to a targeted therapy approach over their treatment course. Brittany Harvey: Great. Thank you for providing that information. So, following that, Dr. Eng, what are the recommendations for patients with colorectal peritoneal metastases? Dr. Cathy Eng: The current recommendations for colorectal cancer with peritoneal disease, really, there's no strong evidence to support the role of heated intraperitoneal chemotherapy. We now know based upon the literature from one of the largest studies to date, the PRODIGE data, demonstrating that there may be some potential benefit from cytoreductive surgery for the patients in regards to overall survival. But these patients are at high risk for bowel obstruction, potentially for perforation, and obviously, quality of life is an issue. So, these patients should always be discussed in a multidisciplinary tumor board whenever possible, and hopefully, to meet with a surgeon that is more experienced, specifically, in treating peritoneal disease, because these patients do require a lot of multidisciplinary care and discussion. So currently, based upon the existing data, we don't recommend heated intraperitoneal chemotherapy, but there may be a role for cytoreductive surgery. Brittany Harvey: Thank you, Dr. Eng for going over those recommendations. So then following that, Dr. Morris, for patients with unresectable liver-limited metastatic colorectal cancer, which liver-directed therapies are recommended? Dr. Van Morris: So, this is I think a really good question and one that just like the prior question with regards to peritoneal surgery, is one that we felt was a challenging one, but a common one that we wanted to address. And specifically, I think this is an example of where level of evidence comes into the strength of recommendation. So, for patients with unresectable liver-limited metastatic colorectal cancer, we looked at the questions of, "What is the role of SBRT - stereotactic body radiotherapy, and what is the role of SIRT, which is selective internal radiotherapy?" And for both of these, we felt that the level of evidence was weak, and I think that it's very important to make note of that in assessing the recommendations. But to start with, for SBRT, we looked at one meta-analysis for patients with oligometastatic colorectal cancer, and also analyzed 18 non-randomized control trials in this setting. Most of the patients in these studies had one to five liver metastases, with the majority having one or two liver metastases. From the meta-analysis, we saw kind of a one-year local control rate of around 67%, a two-year control rate of 59%. So, based on those and recognizing the limitations of non-randomized trials and making recommendations, the panel did feel that it was reasonable to consider use of SBRT for oligometastatic colorectal cancer. The SABR-COMET trial is one that had looked at the role of radiotherapy for treatment of oligometastatic colorectal cancer, and I just want to make the point as well, that we did not include that in our analysis or recommendations at this point in time, because this really didn't include a lot of patients with colorectal cancer that we felt warranted inclusion. Now, with regards to SIRT, we looked at kind of one meta-analysis and three randomized control trials for patients with mostly liver-limited metastatic colorectal cancer. All patients had liver disease, but there were about 40% of the patients we looked at in the meta-analysis, had extra hepatic disease as well. In the frontline setting, there really was no difference in progression-free survival or overall survival with the use of SIRT. And more recently, we've seen in a second-line trial, it was called the EPOCH trial, reported several years ago, this looked at patients with previously-treated metastatic colorectal cancer in the second-line setting. Patients were randomized to either chemotherapy with, or without transarterial radioembolization with Y90. While there was an improvement in overall response rate, there was no meaningful improvement in overall survival with the use of SIRT. But there were significant increases in grade 3 or grade 4 toxicities when SIRT was added to chemotherapy. So, kind of given this, we didn't feel at this point in time that SIRT should be recommended for patients with metastatic colorectal cancer. Although, again, I do want to highlight that really these discussions should be happening at high-volume centers, kind of with a multidisciplinary group of clinicians. Brittany Harvey: Definitely. And thank you for highlighting that multidisciplinary collaboration. And the last section of recommendations, Dr. Eng, what is recommended for patients with metastatic colorectal cancer, and potentially-curable oligometastatic liver metastases? Dr. Cathy Eng: So, another controversial topic. And once again, this is why we decided to include this as part of the guidelines, because this is a common scenario where patients are potentially curable, following liver resection for oligometastatic disease. We cannot highlight enough the importance of multidisciplinary discussion. Prior data has not been strong regarding specific guidelines following liver resection. We do recommend that based upon the existing data, there is no level one evidence to say, you should go one way or another following metastatic resection, and whether or not adjuvant therapy is warranted in that setting. But we do recommend multidisciplinary management and engagement and discussion. So, although it's not definitive, it basically suggests that there is a role for resection. It does provide improved five year survival relative to systemic chemotherapy, if the patient is potentially resectable, but does require multidisciplinary discussion. And it is a shared decision-making process. Brittany Harvey: Great. Thank you. And I appreciate you highlighting the importance of shared decision-making throughout this guideline. So then, Dr. Morris, what is the importance of this guideline in your opinion, and how will it impact clinical practice? Dr. Van Morris: Yeah. So, I think that we understand that management of metastatic colorectal cancer is extremely complex given the various molecular annotations and the multimodality therapies which are possible for our patients. So, we tried to limit the guidelines here to include what we feel are the most recent updates, but also kind of the most clinically-relevant multidisciplinary questions that get asked for treatment of metastatic colorectal cancer. We also recognize that things are changing quickly. And for example, we didn't decide to include at this point in time, management of HER2 neu amplified metastatic colorectal cancer, although we are seeing more and more data coming out, suggesting targeted therapies. So, I think it's important for clinicians to realize that these are guidelines which are ever-changing, given the updates with new therapies available for our patients. And the other thing I think that's very good about these guidelines is that, even though we may be making recommendations about controversial topics in the management of metastatic colorectal cancer - specifically, I think the use of HIPEC with cytoreductive surgery, locally-directed therapies to the liver, and the role of perioperative chemotherapy and metastasectomy - I think it's important for oncologists to realize that these recommendations come with varying strengths of level of evidence and that we as oncologists should be considering the level of evidence that's out there when making recommendations that affect our patients as well. So, we really wanted to support these guidelines and recommendations and empower clinicians to know and understand the quality of evidence that exists in the management of patients with metastatic colorectal cancer. Brittany Harvey: Excellent. And yes, those are key points on the level of evidence and the strength of recommendations throughout the guideline. And then finally, Dr. Eng, you've talked a bit about shared decision-making and the importance of this guideline for patients. So, how will these guideline recommendations affect patients with metastatic colorectal cancer? Dr. Cathy Eng: The reason that we created these guidelines is to help patients, their caregivers, and providers, learn of the most recent developments in colorectal cancer, and the best approach based upon the information that we have personally reviewed with our multidisciplinary team of faculty members that participated in this exercise. We really just want to make sure that patients do get optimal care. And we hope that these guidelines also will help provide a foundation for some of the clinical trials that may be under development, or for other clinical trials that are being considered. So, we really just want to provide the most up-to-date information to all individuals that are interested in colorectal cancer so we can help guide their care better. Brittany Harvey: So, I want to thank you both so much for your work on these guidelines, and all of the time it's spent developing these recommendations, and thank you for your time today, Dr. Morris, and Dr. Eng. Dr. Van Morris: Thank you. Brittany Harvey: And thank you to all of our listeners for tuning into the ASCO Guidelines Podcast series. To read the full guideline, go to: www.asco.org/gastrointestinal-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe, so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.  

COR2ED Medical Education: In the first episode of this GI CONNECT podcast covering the lower gastrointestinal (GI) cancer highlights from ESMO 2022, Dr Jenny Seligmann, Medical Oncologist from the University of Leeds in the UK and Dr Dominik Modest, Medical Oncologist from the Charité Universitaetsmedizin, Berlin, Germany discuss a number of key oral presentations from ESMO 2022 and potential implications for clinical practice. They start their discussion with the NICHE-2 which looked at neoadjuvant immune checkpoint inhibition in locally advanced MMR-deficient colon cancer. Discussion then moves to the HIPECT4 trial which explored adjuvant hyperthermic intraperitoneal chemotherapy in locally advanced colon cancer and challenges previous perceptions of HIPEC in colorectal cancer patients. The FRESCO-2 trial is reviewed which evaluated the efficacy and safety of fruquintinib in patients with refractory metastatic CRC with results potentially supporting a new option for these patients. The experts then review two trials in patients with KRASG12C mutant CRC, the KRYSTAL-1 which used adagrasib with or without cetuximab in these patients and the CodeBreaK101 study which used sotorasib in combination with panitumumab. They discuss their opinions on the results from these studies and the implications for clinical practice.

In this episode, Andy reflects on his HIPEC surgery from one year ago at the Duke Cancer Institute. The Winter Faith Podcast believes all people have seasons of Winter Faith and that doubt is an essential part of faith. Listen to The Winter Faith Podcast on Apple, Spotify, and all other major podcast sites. Support the show on Patreon for more in-depth content and full length interviews. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/winterfaithpod/message

In this rebroadcasted episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Oliver Zivanovic to discuss updates on role of HIPEC in ovarian cancer. Dr. Zivanovic is a Gynecologic Cancer Surgeon at Memorial Sloan Kettering Cancer Center, with the goal to advance the early detection and treatment of women with gynecologic cancers. His special interests include the treatment of patients with advanced stage ovarian cancer and electronic patient-reported symptom monitoring after cancer surgery. Original release date: August 30, 2021

In a subset of patients with metastatic colorectal cancer (mCRC), the peritoneum is the predominant site of dissemination. While cure can be achieved by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), this procedure is associated with long-term morbidity and high relapse rates. In this episode of ModPath CHAT, Drs. Siesing and Jirstrom from Lund University in Sweden discuss their recent study in Modern Pathology on the topic. Multi-region immunohistochemical profiling and deep targeted DNA-sequencing was performed on 7 mCRC patients with peritoneal carcinomatosis (PC). SATB2 was lacking in the majority of cases, and a conspicuous intra-patient heterogeneity was denoted for expression of (RBM3). Mutations in key CRC driver genes, i.e., KRAS, APC and TP53, were homogenously distributed across all samples. The authors conclude that their findings should trigger additional studies addressing the potential distinctiveness of mCRC with PC, which might pave the way for improved personalized treatment of these patients. See acast.com/privacy for privacy and opt-out information.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Robert Bristow, Prof. Christina Fotopoulou, and Dr. Myong Cheol Lim to discuss Secondary Cytoreductive Surgery in Ovarian Cancer. Dr. Bristow is Professor and Chair of the Department of Obstetrics and Gynecology at the University of California, Irvine School of Medicine. His clinical expertise and research interests focus on the surgical management of advanced-stage and recurrent ovarian cancer. Prof. Christina Fotopoulou has served as the Chair of Gynaecological Cancer Surgery at the Department of Surgery and Cancer at Imperial College London, UK. She has served as an elected ESGO council member and Chair of the ESGO guidelines committee. Dr. Myong Cheol Lim is a gynecologic oncologist, working for National Cancer Center Korea. He is fully dedicated to clinical research, including cytoreductive surgery and HIPEC for the management of ovarian cancer. Highlights: - This large meta-analysis on the value of secondary debulking showed that both complete as well as optimal cytoreductive surgery for ovarian cancer relapse significantly increased patients' overall survival. - Median overall survival of a patients cohort increased by 9% and 7% when the complete and optimal cytoreductive rates increased by 10%, respectively, even after adjusting of other well established prognostic factors. - Patients with ovarian cancer relapse should be evaluated for their eligibility for secondary debulking surgery in an effort to improve their survival.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Katherine Kurnit. Dr. Kurnit is an Assistant Professor at the University of Chicago in the section of Gynecologic Oncology. Her research interests include developmental therapeutics and early phase clinical trials for patients with gynecologic cancers. Highlights: Although surgical practices have changed over time, there is still much debate and no consistent consensus about timing or the use of new therapies such as HIPEC. More options for upfront maintenance therapy are now available for ovarian cancer patients. We need new treatment approaches for patients with platinum-resistant ovarian cancer. Finding ways to ensure ovarian cancer care is safe, feasible, and cost-effective in many different settings (nationally and internationally) will be important. New strategies for screening and prevention are sorely needed

In der 3. Folge des Podcast ist Prof. Hünerbein zu Gast. Wir sprechen über das Thema des Tumordebulking + HIPEC. Folgende Publikationen haben wir besprochen. Peritoneal metastasis in gastric cancer: results from the German database; 10.1007/s10120-019-00978-0 Repeated cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy in patients with peritoneal carcinomatosis: A retrospective cohort study; 10.1016/j.amsu.2021.102824 Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial; 10.1016/S1470-2045(20)30599-4

Some cancers can be difficult to treat through traditional chemotherapy. Metastatic appendix, colon and gynecologic cancers that have spread to the lining of the abdominal cavity can fall into this category. In this episode of Advance with MUSC Health, https://education.musc.edu/MUSCApps/facultydirectory/Sutton-Jeffrey (Jeffery Sutton, MD), talks about a surgical treatment that involves using heated chemotherapy inside the abdominal cavity to kill cancer cells. The procedure is called hyperthermic intraperitoneal chemotherapy or HIPEC and offers many patients incredible results.

Experiencing ongoing vomiting and stomach pain, Gemma was diagnosed during the Covid-19 pandemic with stage IV bowel cancer at the age of 35. Stephanie and Gemma talk about the emotional toll of being isolated from her family and friends throughout treatment. Gemma discusses peritoneal metastases, including hyperthermic intraperitoneal chemotherapy (HIPEC), which involves filling the abdominal cavity with chemotherapy that has been heated (also known as 'hot chemotherapy') following surgery to remove cancerous tumours. Passionate about raising awareness and helping other young people, Gemma also discusses the need to connect with a good support network and encourages people to saviour the special milestones and enjoy the things that make you happy.

En este podcast, la Dra. Marytere Herrera, oncólogo médico adscrita al Instituto Nacional de Cancerología en la Ciudad de México, México nos comenta algunos highlights del día 6 de ESMO 2021: Tumores neuroendocrinos: NICE-NEC: Estudio fase II no aleatorizado, abierto, el cual evaluó nivolumab + QT con doblete de platino como tratamiento de 1L en pacientes con tumores neuroendocrinos G3 no resecables, localmente avanzados o metastásicos del tracto gastroenteropancreático o de origen desconocido. Tumores gastrointestinales: CheckMate 649: Estudio fase III aleatorizado, multicéntrico que evaluó nivolumab + quimioterapia (QT) o ipilimumab vs. QT sola como tratamiento de 1L para pacientes con cáncer gástrico avanzado, cáncer de la unión gastroesofágica y adenocarcinoma de esófago. Se demostró incremento en la supervivencia global con la combinación de QT + nivolumab, lo que llevó a la aprobación de la FDA. JUPITER-06: Estudio fase III aleatorizado, doble ciego en donde se evaluó toripalimab vs. placebo en combinación con QT en 1L para pacientes con carcinoma epidermoide de esófago metastásico o avanzado vírgenes a tratamiento, se mostró beneficio en supervivencia global (SG) y supervivencia libre de progresión con un perfil de toxicidad aceptable. DESTINY-Gastric01: Estudio fase II, multicéntrico y abierto de un solo brazo de trastuzumab deruxtecan, el cual evaluó a pacientes occidentales con cáncer gástrico o de unión gastroesofágica irresecable o metastásico HER2 positivo que progresaron durante o después de haber recibido un esquema de tratamiento con trastuzumab. Se observó que trastuzumab deruxtecan incrementó la respuesta y SG al comprarse con el tratamiento de elección. GASTRIPEC: Estudio fase III, aleatorizado multicéntrico que evaluó el uso de la quimioterapia intraperitoneal hipertérmica (HIPEC, por sus siglas en inglés) sobre la cirugía citorreductora (CRS, por sus siglas en inglés) en cáncer gástrico con metástasis peritoneal sincrónica. El estudio no mostró diferencias en la SG en los pacientes tratados con CRS ± HIPEC. PRODIGE 24: Estudio fase III aleatorizado, multicéntrico que comparó la gemcitabina vs. 5-fluorouracilo, leucovorina, irinotecán y oxaliplatino (mFolfirinox) adyuvante en pacientes con adenocarcinoma pancreático resecado, se realizó un seguimiento a 5 años del estudio y se confirmó que mFolfirinox incrementa significativamente la supervivencia libre de enfermedad, SG, supervivencia libre de metástasis y supervivencia específica. NIFE: Estudio fase II aleatorizado, prospectivo que evaluó el uso de nanoliposomal irinotecan (Nal-IRI)+ 5FU + leucovorin como una opción de tratamiento en 1L vs. gemcitabina + cisplatino. Dicho estudio mostró eficacia en la combinación.

In today's episode, we discuss everything you could possibly want to know about hyperthermic intraperitoneal chemotherapy, or HIPEC, with special guest, Dr Ed Pilling. We start by talking about the preceding cryoreductive surgery as well as the principles of HIPEC, before then going on to cover the important aspects of the anaesthesia for this procedure. Feel free to email us at deepbreathspod@gmail.com if you have any questions, comments or suggestions. We love hearing from you!Thanks for listening, and happy studying!

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Drs. Oliver Zivanovic and Roisin O'Cearbhaill. Dr. Roisin O'Cearbhaill, MD, is a medical oncologist and the Research Director of the Gynecologic Medical Oncology Service and the Clinical Director of the Solid Tumor Program, Cellular Therapy Service at Memorial Sloan Kettering Cancer Center, with a joint faculty appointment at Weill Cornell Medical College. Nationally, she serves as the Chair, Developmental Therapeutics, NRG Oncology. Dr. Oliver Zivanovic MD is a Gynecologic Oncologist at the Department of Surgery at Memorial Sloan Ketteting Cancer Center with a joint faculty appointment at Weill Cornell Medical College. He serves as the Institutional Principle Investigator for NRG Oncology. @ROCearbhaill / @zivanovicmd / @TeamOvary_MSK / @sloan_kettering Highlights: -HIPEC with carboplatin at secondary cytoreductive surgery for first platinum-sensitive recurrent ovarian cancer was not superior to secondary cytoreduction without HIPEC. -HIPEC for recurrent ovarian cancer should be conducted in the setting of a clinical trial

In this episode, I am talking to Karen Marszalec who was in the throes of moving from Michigan to Florida in America when we spoke. I am so grateful to her for taking time out of her hugely busy relocation schedule to share her story with me. Karen was diagnosed with Low Grade Serous Ovarian Cancer in 2015 following an abnormal PAP smear, which is very unusual to say the least. The cancer was found in her fallopian tube which is probably why the PAP smear picked up abnormal cells that had migrated. Karen tells me about her initial surgery and disease management including Hyperthermic intraperitoneal chemotherapy (HIPEC) when she experienced recurrent disease in 2020. Karen's healing process didn't exactly go to plan following her initial surgery and she tells how she had post-op complications which resulted in readmission to hospital. We chat about the side effects of the Aromatase Inhibitors because Karen now takes Arimidex as a maintenance treatment. Karen tells me how she coped and how she feels following the diagnosis and subsequent management. After all that she has been through, Karen and her Husband have seized the opportunity to move across country to warmer climes to help alleviate the constant joint pains from her medication. It was a pleasure to chat to Karen today and I wish her all the best for the move to Florida. Karen has asked me to share her email address for anyone who would like to be in touch about anything she has discussed in this episode because she would like to be a support to others. She can be contacted via marszak244@gmail.com During our conversation we mentioned Jane Ludeman, who set up Cure Our Ovarian Cancer. This is a charitable trust that fundraises globally for research to improve the survival of low-grade serous ovarian cancer. Jane is very knowledgeable about this rare sub-type of Ovarian Cancer and her website can be reached here:  https://cureourovariancancer.org We mentioned STAAR (survive, thrive, advocate, advance research) which exists to raise critical funds for life-saving research for those with low-grade ovarian cancer. STAAR was co-founded in 2020 by three low-grade ovarian cancer thrivers Alex Feldt, Bailey Wolfe and Jess BeCraft. You can reach STAAR here: https://www.staaroc.org We also mentioned an international support group for people with Low Grade Serous Ovarian Cancer, which has been invaluable for Karen. I am one of the Administrators of the group. If you apply to join you need to confirm that you have Low Grade Serous Ovarian Cancer or have a loved one with this disease. You can find the group here: https://www.facebook.com/groups/1007723705963894 Thank you so much for listening to ‘Living with Ovarian Cancer'. If you want to get in touch with me or you would like to tell your own story on this Podcast about living with Ovarian Cancer, please email diane.evanswood@gmail.com You can find more information about me on my website by following this link: https://dianeevanswood.wordpress.com Disclaimer: Each story in this Podcast is unique to the woman who is telling it. The content of each episode and the views expressed are not meant to be a substitute for medical advice or intervention. You will hear stories of women who sought alternative therapies, integrated oncology services or even choosing to decline treatment options. If you have a diagnosis of Ovarian Cancer, please make sure that you discuss anything that is going to affect your treatment or wellbeing with your own Medical team.

In this episode, Peritoneal Surface Malignancy Disease Site Workgroup Member, Beth Helmink, MD, PhD, from Washington University in St. Louis, reviews recent data regarding the evolving role of HIPEC in Ovarian Cancer.  Joining her for this discussion are two renowned gynecologic oncologists specializing the treatment of ovarian cancer, Willemien van Driel, MD, Netherlands Cancer Institute, and Ernst Lengyel, MD, PhD, University of Chicago.

Michael Valente, DO, FACS, FASCRS, Associate Professor of Surgery and Program Director of Cleveland Clinic's Colorectal Surgery Residency Program, joins the Cancer Advances podcast to highlight some of the different strategies for treating peritoneal malignancies, including HIPEC. Listen to learn how treatments have evolved and which patients might be good candidates.

Episode 16: Dr. Andrea Hayes-Jordan Dr. Andrea Hayes-Jordan is the Byah Thomason Doxey-Sanford Doxey Distinguished Professor, and Chief of the Division of General Pediatric Surgery at the University of North Carolina School of Medicine. She is also the surgeon-in-chief at the North Carolina Children's Hospital, as well as the first board-certified Black female pediatric surgeon in the United States, and the first person to perform pediatric HIPEC surgery for sarcomatosis. She joins Dr. Mezrich to share her journey through these accomplishments, her experience as an aspiring Black female surgeon, and how she prioritizes the many elements of her life. Follow us on Twitter: @WiscSurgery Give our Facebook page a like: @WiscSurgery Follow us on Instagram: @WiscSurgery

Interview with Ignace H. de Hingh, and Koen P Rovers, authors of Perioperative Systemic Therapy vs Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Alone for Resectable Colorectal Peritoneal Metastases: A Phase 2 Randomized Clinical Trial

Interview with Ignace H. de Hingh, and Koen P Rovers, authors of Perioperative Systemic Therapy vs Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Alone for Resectable Colorectal Peritoneal Metastases: A Phase 2 Randomized Clinical Trial

Trimester 1,2,3,4,5- Pregnancy and Beyond, You can Survive The first trimester is the earliest phase of pregnancy. It starts on the first day of your last period -- before you're even actually pregnant -- and lasts until the end of the 13th week. The changing body 1. Fatigue 2. Morning sickness 3. Breast tenderness 4. Bleeding Emergency Symptoms During the First Trimester 1. Severe abdominal pain 2. Heavy bleeding 3. Severe dizziness 4. Rapid weight gain or too little weight gain Prenatal vitamin   Ob-Gyn visits What/how much should I eat during pregnancy? Exercise Avoid putting pressure on your abdomen. Get rest and move your body to keep your muscles healthy. Bring up any concerns with your doctor.   Cases to avoid? 1. Total joints- Bone cement aka methyl methacrylate- O2 mask, Z 2. Radiation- maximal fetal dose should not exceed 0.5 rem/ 50mrem/ month- ionizing radiation XRAY, IR-->double lead, step out, fetal dosimeter 3. Cytotoxic agents- chemotherapy, HIPEC 4. Peds- inhaled inductions with nitrous 5. CMV - Transplant cases 6. Extracorporeal shockwave lithotripsy (ESWL) --Noise→ fetal hearing Childcare- nanny vs daycare 1. Consider your lifestyle and specific needs 2. Get childcare lined up ASAP, especially if you live in a big city Maternity leave/ FMLA rules 1. Do research on your hours etc. early on to take care of future you   Send an email to: Hello@anesthesiamom.com IG: @Stethoscopes.to.Swaddles Please leave a review, it helps the show so much Information sources: pregnancy-info

The multimodal approach for patients with peritoneal carcinomatosis involves what is known as cytoreductive surgery, followed by hyperthermic intraperitoneal chemotherapy (HIPEC). The specifics of this treatment regimen and how it is performed is not something we typically discuss outside of service specific surgical oncology conferences. To better prepare our residents and medical learners out there, today we sit down with our Chief Surgical Resident, Constantinos Zambirinis, MD to discuss the evolution, patient management, and future applications of HIPEC therapy. Follow Dr Zambirinis on Twitter at: @czambir

In this episode, Alex Kim, MD, PhD, explains the innovation of hyperthermic intraperitoneal chemoperfusion (HIPEC). It's a complicated procedure in which heated chemotherapy is injected into a patient as part of the surgery to remove their metastatic tumors. HIPEC, Kim explained, is used most often to treat colorectal cancers that have spread to the stomach. “First, we surgically remove any visible tumors that are within the belly cavity,” he said. “But, we know there can still be some cancer cells there.” To “kill” these cells, the heated chemotherapy is injected using a catheter and profusion device. Heating the chemotherapy allows the anti-tumor agents to better penetrate the outer cellular membranes of cancer cells.

In this episode, Edward Levine, MD Chair of the SSO Peritoneal Surface Malignancy DSWG, is joined by Brian Badgwell, MD of MD Anderson Cancer Center and Pieter Tanis, MD, PhD of the University of Amsterdam.  They discuss whether patients at high risk of peritoneal dissemination from gastric and colon cancers should undergo HIPEC as an adjuvant therapy. 

Sejam bem vindos ao Clinical Papers Podcast!Neste episódio, iremos discutir um paper publicado agora em fev/2021 na LANCET Oncology: O Estudo PRODIGE 7. Nele, seus autores, avaliaram o papel da HIPEC, após a realização da cirurgia de citorredução completa, em pacientes com metástase peritoneal de origem colorretal. Entenda como os autores pensam e qual o racional deste importante Estudo.Para saber mais sobre o paper, acesse: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30599-4/fulltext

Robert DeBernardo, MD, Section Head of Gynecologic Oncology at Cleveland Clinic Ob/Gyn & Women’s Health Institute joins the Cancer Advances podcast to discuss hyperthermic intra-peritoneal chemotherapy (HIPEC), specifically in gynecologic cancers. Listen as Dr. DeBernardo discusses the procedure and use of HIPEC along with the type of patient and cancers that are ideal for HIPEC treatment.

Dr. Paul Sugarbaker joined us for an interview about HIPEC (hyperthermic intraperitoneal chemotherapy) for peritoneal mesothelioma. Paul Sugarbaker, MD, FACS, FRCS, is the Chief of the Peritoneal Surface Malignancy Program and the Director of the Center for Gastrointestinal Malignancies at the Washington Hospital Center in Washington, DC. MesoTV is the Mesothelioma Applied Research Foundation's recorded series covering pertinent conversations impacting the mesothelioma community. You can learn more at curemeso.org/mesotv. The Mesothelioma Applied Research Foundation is the only nonprofit charity organization dedicated to ending mesothelioma, and the suffering caused by this cancer, by: funding research to improve treatment options; providing treatment support and education for patients and their families; and advocating for federal funding of research.  

Louise is an artist, administrator and writer from Norwich in the UK. She was originally diagnosed with a rare form of appendix cancer in 2014 and again in 2017. She is currently recovering from her second surgery. 0:00:00 How the cancer was discovered0:05:19 Louise lands at Basingstoke Hospital0:10:12 Treatment: Pseudomyxoma peritonei (PMP) & hyperthermic intraperitoneal chemotherapy (HIPEC)0:14:15 The immediate impact on Louise and her loved ones0:20:21 Urgency for treatment0:25:05 Time to let it all in0:32:19 Cancer awareness 0:40:58 Cancer clichés0:45:30 Mindset going into surgery0:50:30 Chemo baths1:02:50 Finding your way back up1:08:48 Long-term effects of treatment1:22:00 How the body communicates with us1:26:50 Your reality anchor1:35:41 Removal of the mucinous carcinoma1:39:40 The power of laughter 1:41:09 Supporting those grieving our diagnosis1:48:22 The mother of all surgeries1:52:52 Caregivers2:01:25 Calling doctors by their first name2:08:05 Followup scan2:17:40 Life “extending” surgery2:22:05 We are not our bodies2:28:00 Living the only life we have www.PseudomyxomaSurvivor.orghttps://mypmpexperience.wordpress.com

Vadim Gushchin, MD, Brian Badgwell, MD, and Jeremy Davis, MD discuss the role and timing of preoperative treatments before cytoreduction and HIPEC for gastric cancer. The panelists offer useful tips on surgical management of gastric cancer patients with peritoneal carcinomatoses, such as how to decide on the extent of the surgery, whether patients with CDH1 mutation should be treated differently, and others.

“You save a life of a child, you save generations.” - Dr. AndreaOur guest for today is the first African-American female pediatric surgeon in the country and today, she shares how she leads as a surgeon and an educator. We talked about her clinical research efforts and how she has changed and saved lives. I really enjoyed this episode and I learned so much from Dr. Jordan and I am sure you will too.Who is Dr. Andrea Hayes-Jordan?She is a Distinguished Professor of pediatric surgery and surgical oncology at the University of North Carolina Children's Hospital.  She is the Surgeon-in-Chief of the UNC Children's Hospital and the division chief of pediatric surgery at UNC. She has a basic science laboratory that focuses on rare sarcomas and also maintains clinical research efforts. She is nationally and internationally known for her work pioneering an operation known as HIPEC for children.How to connect with Dr. Jordan?Twitter: https://twitter.com/AHayesJordanShow notes:[0:00] Intro[2:13] Guest intro and Dr. Andrea's background story[4:54] On working with kids and kids with cancer[10:37] It's easier to connect the dots looking backward[14:24] The number of lives saved[17:08] Splitting time between teaching and surgery[18:45] On being an educator[20:11] Toughest part of the role: time[21:56] What makes someone tomorrow's leader?[25:52] Acknowledging your blind spots[29:22] On viewing, navigating, and leading through change[34:29] Risk-taking as a leader[36:53] Swimming on unchartered waters: Dr. Andrea's journey[40:04] Words of wisdom from Dr. Andrea[41:44] Where to find Dr. Andrea Hayes-Jordan[42:42] OutroText LEADER to 617-393-5383 to receive The Top 10 Things That The Best Leaders Are Doing Right NowFor questions, suggestions, or speaker inquiries, contact me at john@lauritogroup.com 

Hear transcribed versions of author submitted video abstracts, including rectal cancer, diverticulitis, HIPEC, pelvic floor, and more!

Researchers are conducting the first U.S. trial of pressurized intraperitoneal aerosolized chemotherapy (PIPAC) for the treatment of peritoneal carcinomatosis in patients with gynecologic or gastrointestinal cancers. Coprincipal investigator Thanh H. Dellinger, MD, of City of Hope in Duarte, Calif., describes this trial and the PIPAC procedure to host David H. Henry, MD, in this episode. To start, the pair discuss a patient who might be eligible for PIPAC – one with stage 3 ovarian cancer. General approach to stage 3 ovarian cancer Therapy typically includes a combination of surgery and chemotherapy. The order in which chemotherapy is given, either pre- or postoperatively, depends on performance status and whether patients have extra-abdominal disease or parenchymal liver disease. Operative approaches, including debulking surgery, are pursued if believed to be optimal, meaning all gross residual disease can be resected. If all residual disease cannot be resected, patients are offered neoadjuvant chemotherapy, typically for three to four cycles before an interval debulking surgery, followed by postoperative adjuvant chemotherapy. Intraperitoneal chemotherapy Intraperitoneal (IP) chemotherapy is used to treat peritoneal surface malignancies. The peritoneum is a separate organ that is difficult to treat adequately with intravenous chemotherapy alone. Giving IP chemotherapy in combination with intravenous chemotherapy may be more effective than intravenous chemotherapy alone (N Engl J Med. 2006; 354:34-43; https://bit.ly/3g3lngx). However, there are many challenges in delivering IP chemotherapy, including increased side effects of abdominal pain and IP catheter failure. Recent clinical trials have shown that, with the addition of bevacizumab, the survival benefit with IP chemotherapy may not be as significant as prior trials suggested (J Clin Oncol. 2019 Jun 1;37[16]:1380-90; https://bit.ly/2VAmRVW). In general, IP chemotherapy has not been embraced by the medical oncology community as much other types of chemotherapies, Dr. Dellinger said. What is PIPAC? PIPAC is a novel therapy discovered by a German surgical oncologist, Marc A. Reymond, MD, from University of Tuebingen (Germany). PIPAC delivers chemotherapy at a reduced dose directly into the intraperitoneal cavity but in a pressurized and aerosolized form. PIPAC is done at the time of the diagnostic laparoscopy and requires a nebulizer for aerosolization of the chemotherapy as well as a high-pressure injector. This approach allows for the chemotherapy to be pushed deeper into tissues, compared with hyperthermic intraoperative peritoneal chemotherapy (HIPEC). With HIPAC, tissue penetration is typically 1 mm or less. With PIPAC, there is deeper penetration and better distribution of chemotherapy throughout the entire intraperitoneal cavity. With PIPAC, chemotherapeutic agents are given at a lower dose than is typically administered with IP or intravenous chemotherapy, which helps in reducing the toxicity. PIPAC is given every 6 weeks for three cycles, requiring three laparoscopic procedures. These laparoscopic procedures allow for the opportunity to obtain peritoneal tumor biopsies before and after to investigate the natural course of these tumors and their microenvironment. Toxicity of PIPAC PIPAC has been done in more than 800 patients with gastrointestinal and gynecologic cancers in Europe and Asia. Severe adverse events  have been minimal, with about 12%-15% grade 3/4 SAEs and very rare grade 5 SAEs. The most common side effect is typically abdominal pain, attributed to the IP administration in conjunction with the laparoscopic surgery. Renal toxicity is a concern with intravenous cisplatin use, but this has not yet been seen with PIPAC. With PIPAC, cisplatin is given at 10.1 mg/m2 and doxorubicin is given at 2.1 mg/m2, doses that are much lower than the typical doses for these drugs. PIPAC in clinical trials PIPAC clinical trials have moved into phase 2 in Europe for ovarian cancer, with a publication demonstrating an objective response rate of over 60% in platinum-resistant ovarian cancer (Gynecol Oncol. 2015 May;137[2]:223-8; https://bit.ly/2KY701r). A phase 3 trial of PIPAC was planned but was stalled because of the COVID-19 pandemic. Because of the need for Food and Drug Administration approval, researchers have just launched the first phase 1 trial of PIPAC in the United States. Phase 1 trial of PIPAC City of Hope is working with affiliates at Mayo Clinic in Jacksonville, Fla.; Northwell Health in New York; and the National Institutes of Health to enroll eligible candidates for a phase 1 trial (NCT04329494; https://bit.ly/3qs8H7U). Eligible candidates include those with gastric, uterine, colorectal, appendiceal, and ovarian cancer with evidence of peritoneal carcinomatosis who have failed at least one line of therapy. PIPAC is an outpatient procedure, but given the trial and need for monitoring, patients typically leave the hospital the following day after blood samples are obtained for the study. City of Hope has recruited seven patients since activating their study in August 2020, with a goal of enrolling 16 patients by spring 2021. Future directions Peritoneal tumor biopsies obtained during the laparoscopic procedures are being used to study the microenvironment of these cancers. In eventual phase 2 clinical trials, the researchers may include immune checkpoint inhibitors. Biomarker analyses are underway, looking at expression of PD-1 and tumor-infiltrating lymphocytes. The researchers are also studying the role of genomic sequencing and DNA repair. Disclosures: Dr. Dellinger and Dr. Henry have no financial disclosures relevant to this episode. Show notes by Sheila De Young, DO, resident at Pennsylvania Hospital, Philadelphia. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

In this rebroadcasted episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Oliver Zivanovic to discuss updates on role of HIPEC in ovarian cancer. Dr. Zivanovic is a Gynecologic Cancer Surgeon at Memorial Sloan Kettering Cancer Center, with the goal to advance the early detection and treatment of women with gynecologic cancers. His special interests include the treatment of patients with advanced stage ovarian cancer and electronic patient-reported symptom monitoring after cancer surgery.

Only a handful of hospitals in the country offer an innovative procedure known as HIPEC to treat rare forms of cancer.

Dr. Melanie Ongchin, surgical oncologist at the UPMC Hillman Cancer discusses the use of an innovative surgery known as HIPEC to treat peritoneal carcinomatosis, a rare type of cancer that can develop when gastrointestinal or gynecologic cancers spread. 

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Oliver Zivanovic to discuss updates on role of HIPEC in ovarian cancer. Dr. Zivanovic is a Gynecologic Cancer Surgeon at Memorial Sloan Kettering Cancer Center, with the goal to advance the early detection and treatment of women with gynecologic cancers. His special interests include the treatment of patients with advanced stage ovarian cancer and electronic patient-reported symptom monitoring after cancer surgery.

Host: John J. Russell, MD Guest: Nabil Wasif, MD Image: Mayo Foundation For Medical Education and Research. All Rights Reserved. Short for hyperthermic intraperitoneal chemotherapy, HIPEC is a form of treatment for advanced cancers of the gastrointestinal tract, like metastatic appendix, colon, and ovarian cancers. And after a recent Mayo Clinic study investigated the survival rates of patients who received HIPEC, Dr. Nabil Wasif joins us to discuss the study’s results as well as the benefits and drawbacks of HIPEC. For more information about referring a patient to Mayo Clinic, please visit mayoclinic.org and for continuing medical education opportunities visit ce.mayo.edu.

Host: John J. Russell, MD Guest: Nabil Wasif, MD Image: Mayo Foundation For Medical Education and Research. All Rights Reserved. Short for hypothermic intraperitoneal chemotherapy, HIPEC is a form of treatment for advanced cancers of the gastrointestinal tract, like metastatic appendix, colon, and ovarian cancers. And after a recent Mayo Clinic study investigated the survival rates of patients who received HIPEC, Dr. Nabil Wasif joins us to discuss the study’s results as well as the benefits and drawbacks of HIPEC. For more information about referring a patient to Mayo Clinic, please visit mayoclinic.org and for continuing medical education opportunities visit ce.mayo.edu.

Dr. Brendan Moran discusses HIPEC and cytoreductive surgery principles. Listen up to this very educational episode and interesting talk about HIPEC study and controversies. 

Hear transcribed versions of author-submitted video abstracts for the October 2019 edition of DC&R.  Includes lateral nodes & lap vs. open CRM in rectal cancer, colorectal lymphoma, HIPEC, mental health in FAP, perineural invasion prognostic impact, LIFT, TAP blocks, and more!

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Igance Vergote to talk about HIPEC in advanced ovarian cancer. Professor Ignace Vergote is Chairman of the Department of Gynaecology and Obstetrics at the Catholic University Leuven since 2003. He published more than 900 papers on gynecologic cancer in peer-reviewed journals and his work was cited more than 50.000 times. He served as President of IGCS, ESGO, EORTC-GCG and ENGOT.

In 2005 Wendi was diagnosed with stage 3 metastatic ovarian cancer. She also tested positive for the BRCA 1 gene. After treatment, which included a hysterectomy and prophylactic double mastectomy, she was pronounced "cured" after five years. Early in 2019, after 14 years her cancer returned. During our conversation we discussed: How a case of appendicitis led to the diagnosis of her cancer recurrence. The challenges she now faces with the metastasis to her peritoneum. HIPEC as an option for treatment of her cancer recurrence. The long-term side effects of her initial treatment and how it's impacted her life. How her cancer recurrence has impacted decisions on her life moving forward. How turning to her faith has brought her comfort. Links Mentioned In the WE Have Cancer Podcast Connect with Wendi - http://wendicooper.com/ WE Have Cancer Links Subscribe to the show - https://pod.link/wehavecancer Follow WE Have Cancer on Social Media Like our Facebook page - https://www.facebook.com/wehavecancershow/ Join our private Facebook group - https://www.facebook.com/groups/wehavecancershow/ Follow us on Twitter - https://twitter.com/wehavecancerpod Follow us on Instagram - https://instagram.com/wehavecancerpod Follow us on LinkedIn - https://linkedin.com/company/wehavecancer Know someone touched by cancer who has an inspiring story? Nominate a guest to appear on the podcast - https://wehavecancershow.com/guest Email Lee Lee@wehavecancershow.com

The HIPEC team at Penn Medicine is led by surgical oncologist Dr. Giorgos Karakousi. The HIPEC team includes specialists from medical oncology, anesthesiology, pathology, radiology, and critical care.Giorgos Karakousis MD, FACS discusses why HIPEC is usually performed at academic medical centers like Penn Medicine and shares what makes it one of the most innovative treatments available today for complex cancers.

Dr. West asks Dr. Cathy Eng, Co-Director of GI Oncology at Vanderbilt-Ingram Cancer Center, about several debated questions in management in GI oncology, ranging from liver resections in colorectal cancer to HIPEC to optimal aggressive chemo regimens.

Recurring guest Dr. Michael Valente provides insight into HIPEC, an alternative and innovative method of delivering chemotherapy used to treat cancers that have spread to the lining of the abdominal cavity. Unlike traditional chemotherapy that is delivered intravenously, HIPEC delivers chemotherapy directly into the abdomen. Listen to learn how the process works and when HIPEC is a recommended treatment option.

Howard Brown was first diagnosed with cancer - Non-Hodgkins Lymphoma - at the age of 24. When he turned 50, a routine colonoscopy revealed stage 3 colon cancer. During our conversation we discussed: The numerous treatments, including HIPEC, and clinical trials he's been through. His experience as an an attendee of the 2019 American Association of Cancer Research (AACR) conference. How his twin sister saved his life from stage 4 Non-Hodgkins Lymphoma. The possible link between childhood and young adult cancers to adult cancers. His experience being treated with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) What his cancer experience has taught him about himself. How exercise has helped him physically and emotionally. His thoughts, and mine, on healthy eating. Links Mentioned In the Show Stacy Hurt - https://stacyhurt.net/ AACR - https://www.aacr.org/Pages/Home.aspx Gentle Yoga With Jean DiCarlo Wagner - https://Wehavecancershow.com/019 Colontown - https://colontown.org/colontown-intake-form/ Belong.Life App - https://belong.life/ WE Have Cancer Links Subscribe to the show - https://pod.link/wehavecancer Follow WE Have Cancer on Social Media Like our Facebook page - https://www.facebook.com/wehavecancershow/ Join our private Facebook group - https://www.facebook.com/groups/wehavecancershow/ Follow us on Twitter - https://twitter.com/wehavecancerpod Follow us on Instagram - https://instagram.com/wehavecancerpod Follow us on LinkedIn - https://linkedin.com/company/wehavecancer Know someone touched by cancer who has an inspiring story? Nominate a guest to appear on the podcast - https://wehavecancershow.com/guest Email Lee Lee@wehavecancershow.com

Com o objetivo de comparar Mitomicina C vs. Oxaliplatina na HIPEC para pacientes com Câncer Colorretal, os autores desse paper avaliaram, de modo retrospectivo, mais de 200 pacientes em termos de sobrevida. O dr. David Morris e seus colaboradores concluíram que os pacientes que receberam oxaliplatina (n=106) durante a HIPEC tiveram melhores taxas de sobrevida global (56 vs. 29m) quando comparados com os que usaram mitomicina (n=96). Interessante dizer que a sobrevida livre de doença foi igual! https://www.ncbi.nlm.nih.gov/pubmed/27780675 Quer saber mais sobre a discussão desse trabalho? Acesse o spotify ou podcast no seu smartphone, ou acesse o nosso site: www.clinicalpaperspodcast.com.br

Robert Figlin, MD, Steven Spielberg Family Chair in Hematology-Oncology, Cedars-Sinai Medical Center and Axel Grothey, MD, Director of GI Research, West Cancer Center, University of Tennessee, discuss new data from the BEACON study and the role of I-O and HIPEC in colorectal cancer

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. David Gershenson (Twitter: @RareOvarCancers) from MD Anderson Cancer Center in Houston, Texas to talk about the management of rare ovarian tumors in ovarian cancers, including mucinous, clear cell, and small cell. They discuss metastatic vs. primary mucinous tumors, the role of HIPEC in the treatment of advanced disease, as well as genomic profiling. Look out for IJGC's upcoming pdocast with Dr. Gershenson on updates on management of low-grade ovarian tumors.

Hi! Listen to the second part of my cancer summary. This episode covers the side effects I endured during the start of my chemotherapy, FOLFOX, and the surgery I had (HIPEC surgery). It was a crazy and unexpected ride but I would do it all over again.Contact info to send questions to the podcast are listed below.Email: vixmixpodcast@gmail.comVoiceMail: 505-333-8232Instagram: @vixmixpodcast

Hi! Listen to the second part of my cancer summary. This episode covers the side effects I endured during the start of my chemotherapy, FOLFOX, and the surgery I had (HIPEC surgery). It was a crazy and unexpected ride but I would do it all over again.Contact info to send questions to the podcast are listed below.Email: vixmixpodcast@gmail.comVoiceMail: 505-333-8232Instagram: @vixmixpodcast

Ovarian cancer is one of the more challenging forms to treat, especially when diagnosed at advanced stages. But that may be changing thanks to a specialized form of chemotherapy called Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Our guests include gynecologic oncologist Dr. Jack Basil and Farah Kahn, the first TriHealth patient to be treated for ovarian cancer with HIPEC.

A procedure for certain stage-4 abdominal cancers, combining surgery and a specialized chemo-therapy treatment, is proving to be successful in giving patients both quantity and quality of life back. On today’s show, learn about the procedure known as HIPEC. We’ll also hear from someone in our community who was treated with HIPEC. And later, we’ll focus on clinical trials, as we learn how trials are carefully reviewed to assure the safety and protection of their participants. That’s all coming up inside this edition of CTSI Discovery Radio!

Hear section editor Kelly Bullard Dunn give insights into Current Status manuscripts and author Gianluca Pellino discuss how guidelines differ between Asian vs. Western countries regarding the management of colon cancer.

Pediatric Grand Rounds for Wednesday, January 17, 2018 Andrea Hayes-Jordan, MD Chief, Pediatric Surgery/Pediatric Surgical Oncology Professor of Surgery and Pediatrics University of Texas MD Anderson Cancer Center

Researchers at Roswell Park Comprehensive Cancer Center have determined that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CS/HIPEC), a complex procedure to treat advanced abdominal cancers, can be done safely, and may be an effective therapy for select patients. In this fascinating segment, Valerie Francescutti, MD., disusses Cytoreduction Surgery and Hyperthermic Intraperitoneal Chemotherapy as a way to improve survival, surgical outcomes, and when to refer to a specialist.

Researchers at Roswell Park Comprehensive Cancer Center have determined that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CS/HIPEC), a complex procedure to treat advanced abdominal cancers, can be done safely, and may be an effective therapy for select patients. In this fascinating segment, Valerie Francescutti, MD., disusses Cytoreduction Surgery and Hyperthermic Intraperitoneal Chemotherapy as a way to improve survival, surgical outcomes, and when to refer to a specialist.

Hear Brendan Moran and Haney Yousef discuss peritoneal malignancy - and specifically ovarian involvement with tumors. Lots of great inside information on this complex topic!

The Christ Hospital Health Network is proud to welcome Rod Flynn, MD. Dr. Flynn is a surgical oncologist and brings extensive experience and a new treatment focus to The Christ Hospital Health Network-Hyperthermic Intraperitoneal Chemotherapy (HIPEC), a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery.In this segment, we meet Dr. Flynn as he explains the HIPEC treatment and why it is so beneficial for certain cancer patients.

This episode features discussion on Heated Intraperitoneal Chemotherapy (HIPEC) treatment. The experts joining the podcast to discuss this type of care are Dr. Nelya Melnitchouk and Dr. Tom Abrams from the GI team at the Dana Farber/Brigham and Women's Cancer Center in Boston. HIPEC differs from other treatments because of the specific and targeted delivery method. The chemo does not circulate through the entire body during HIPEC. It only is directed at the cancerous cells in the abdomen area.

HIPEC, or heated intraoperative peritoneal chemotherapy, is an alternative method of delivering chemotherapy. Instead of infusing the medications through a vein, the chemotherapy is circulated in the abdominal cavity at the time of surgery. This allows direct treatment of certain cancers which have spread throughout the abdomen.At City of Hope, our peritoneal surface malignancy team consists of a multidisciplinary group of experts in the field. We are one of the busiest HIPEC centers in Southern California, and continue to push the envelope in treating these difficult cancers. The team will evaluate your case and present options. Not everyone will be a candidate for HIPEC and aggressive surgery, but other treatments may be available.Byrne Lee, M.D is here to explain how studies are showing that HIPEC with aggressive surgery improves survival in some cancers when compared to chemotherapy alone.

Procedures like Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) and minimally invasive robotic surgery offer new hope for patients in the advanced stage of ovarian cancer.Until recently, treatment options for patients with advanced-stage ovarian cancer have only included surgery and conventional chemotherapy.However, with HIPEC and robotic surgery, surgeons can potentially improve their odds and reduce the morbidity associated with traditional open procedures.Joongho Shin, MD, is here to explain the Robotics and HIPEC Programs at Palmdale Regional Medical Center.

Host: Lee Freedman, MD Heated/Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is one of the most innovative treatments available today for complex abdominal cancers. What is it? Who is a candidate? And, what are the expected outcomes for our patients? Host Dr. Lee Freedman welcomes Dr. Giorgos Karakousis, Assistant Professor of Surgery at the Hospital of the University of Pennsylvania to discuss HIPEC.

Host: Lee Freedman, MD Heated/Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is one of the most innovative treatments available today for complex abdominal cancers. What is it? Who is a candidate? And, what are the expected outcomes for our patients? Host Dr. Lee Freedman welcomes Dr. Giorgos Karakousis, Assistant Professor of Surgery at the Hospital of the University of Pennsylvania to discuss HIPEC.

Thu, 18 Oct 2012 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/15147/ https://edoc.ub.uni-muenchen.de/15147/1/Novotna_Jaroslava.pdf Novotna, Jaroslava ddc:610, ddc:6

Thu, 17 Nov 2011 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/13666/ https://edoc.ub.uni-muenchen.de/13666/1/Hauer_Alexandra.pdf Hauer, Alexandra

Hyperthermic intraperitoneal chemotherapy (HIPEC) delivers chemotherapy directly into the abdominal cavity. It is used in conjunction with cancer surgery for people with advanced cancer that has spread inside the abdomen. “Hyperthermic” means warm or hot. “Intraperitoneal” means inside the abdominal cavity, which is encased in a sac called the peritoneum. HIPEC uses high-dose chemotherapy to kill microscopic cancer cells inside the abdominal cavity. The HIPEC procedure is performed immediately after a surgeon has removed all visible cancer in the abdomen. HIPEC is well studied in several types of cancer and being explored as a potential treatment in others. "So really any cancer that's just localized in the abdomen on the surface of the peritoneum could be a candidate," explains Dr. Travis Grotz, a Mayo Clinic surgical oncologist. "We know for sure, based on studies and data that HIPEC works well for cancers of the colon, cancers of the appendix, cancer to the ovaries, cancer of the stomach, and there's even a cancer of the lining of the peritoneum, called mesothelioma. So those would be the cancers I think that are well studied and well accepted. Then, there are more rare tumors that we have less data for, such as cancer to the pancreas or gallbladder or small intestine, that we don't know yet if that's the right treatment."The specific type of chemotherapy used for HIPEC varies depending on the type of cancer being treated. The abdominal cavity is bathed with hot chemotherapy to kill any microscopic cancer cells that might still be present. Heating the chemotherapy enhances its effectiveness because, when it's hot, chemotherapy penetrates the tissue more deeply, increasing the number of cancer cells it can reach.On this Mayo Clinic Q&A podcast, Dr. Grotz explains what HIPEC is, how it is performed, and the risks and benefits of the treatment.Related Articles: "New therapies bring hope for ovarian cancer." "Alternative chemotherapy offers hope for late-stage cancers." "Aggressive treatment turns tide in fighting colon cancer." Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy