Pressurised intraperitoneal aerosolised chemotherapy (PIPAC) for gastric cancer with peritoneal metastases: A systematic review by the PIPAC UK collaborative. (December 2022) - Case, A.
Abstract: Introduction: Gastric cancer with peritoneal metastases (GCPM) carries a poor prognosis. Pressurised Intraperitoneal Aerosolised Chemotherapy (PIPAC) offers pharmacokinetic advantages over intravenous therapy, resulting in higher chemotherapy concentrations in peritoneal deposits, and potentially reduced systemic absorption/toxicity. This review evaluates efficacy, tolerability and impact on quality of life (QOL) of PIPAC for GCPM. Methods: Following registration with PROSPERO (CRD42021281500), MEDLINE, EMBASE and The Cochrane Library were searched for PIPAC in patients with peritoneal metastases, in accordance with PRISMA standards Results: Across 18 included reports representing 751 patients with GCPM (4 prospective, 11 retrospective, 3 abstracts, no phase III studies), median overall survival (mOS) was 8 – 19.1 months, 1-year OS 49.8–77.9%, complete response (PRGS1) 0–35% and partial response (PRGS2/3) 0–83.3%. Grade 3 and 4 toxicity was 0.7–25% and 0–4.1% respectively. Three studies assessing QOL reported no significant difference. Conclusion: PIPAC may offer promising survival benefits, toxicity, and QOL for GCPM. Graphical Abstract: ga1 Highlights: PIPAC enhances absorption of chemotherapy in peritoneal metastases. Phase I/II overall survival data is promising for gastric peritoneal carcinomatosis. Reported rates of PIPAC associated grade ≥ 3 toxicity and death are low. Quality of life is not impaired by PIPAC treatment. Phase 3 trials are needed to confirm these findings.