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Studies review new drug and indications
for heated Chemotherapy
Newswise — Studies have
shown that surgery combined with
Intraperitoneal Hyperthermic Chemotherapy (IPHC)
can improve survival rates for select
patients with peritoneal carcinoma (cancer
of the lining of the abdominal cavity) that
has spread from colorectal or appendix
cancer.
Researchers from Wake
Forest University School of Medicine will
present findings from two studies on the use
of IPHC in treating peritoneal cancer that
has spread from these two primary cancer
sites at the annual meeting of the Society
of Surgical Oncology in Chicago, March
13-16.
John H. Stewart, IV,
M.D., assistant professor of surgery,
section of surgical oncology, reports March
13 on the results of a study evaluating
toxicity when combining surgery and IPHC
using oxaliplatin as the chemotherapy agent
in patients with peritoneal cancer which
originated as colorectal or appendix cancer.
“A large body of
literature suggests that oxaliplatin is
superior to other chemotherapy agents in
killing colorectal cancer cells,” said
Stewart.
“Further, we have previously
demonstrated that the cancer-killing effects
of oxaliplatin are increased when the agent
is heated during perfusion.”
The purpose of the
phase I study was to establish the maximum
tolerated dose of oxaliplatin used in IPHC
treating colorectal and appendix cancers
that have spread to the peritoneum.
Fifteen patients were
enrolled in the study at two dose levels,
200 mg/m² and 250 mg/m². At the maximum
tolerated dose of 200 mg/m², only two
significant toxicities were encountered.
More severe toxicities were observed in
patients receiving 250 mg/m².
Researchers concluded
that IPHC with 200 mg/m² of oxaliplatin is
well tolerated and is the maximally
tolerated dose for a two-hour chemoperfusion.
“Based on the data from
this phase I study, we propose to conduct a
larger trial with oxaliplatin dose to study
its efficacy in improving outcomes in
patients with peritoneal carcinoma,” said
Stewart.
On March 14, Perry Shen,
M.D. associate professor, section of
surgical oncology, will report findings on
the use of IPHC in patients with peritoneal
cancer and hepatic metastases (HM), or liver
cancer that has metastasized from colorectal
cancer. The use of IPHC in patients with
this presentation is controversial.
“This was a
retrospective study of 144 patients
undergoing surgery to remove as much of the
cancer as possible and IPHC between 1991 and
2007,” said Shen.
There were 17 patients
with HM. Clinical and pathological
information was obtained from a
prospectively collected database and
electronic medical record.
Median overall survival
for patients with and without HM was 22.7
months and 15.8 months respectively, which
was not a significant difference.
Two- and
four-year survival rates for the HM patients
were 34.0 percent and 11.3 percent. Further
analysis demonstrated the presence of
malignant fluid in the abdominal cavity to
be a significant predictor of decreased
survival in patients with HM.
“We concluded that
patients with peritoneal carcinoma and
hepatic metastases undergoing cytoreductive
surgery and IPHC for colorectal cancer had
no significant difference in overall
survival compared to those without HM,” said
Shen.
“In select patients with peritoneal
carcinoma and hepatic metastases, cytoreductive surgery and IPHC may have some
benefit.”
Malignant ascites, an accumulation
of fluid in the peritoneal cavity, predicted
a poor outcome.
Wake Forest University
Baptist Medical Center is an academic health
system comprised of North Carolina Baptist
Hospital, Brenner Children’s Hospital and
Wake Forest University Health Sciences,
which operates the university’s School of
Medicine and Piedmont Triad Research Park.
The system comprises 1,154 acute care,
rehabilitation and long-term care beds and
has been ranked as one of “America’s Best
Hospitals” by U.S. News & World Report since
1993. Wake Forest Baptist is ranked 32nd in
the nation by America’s Top Doctors for the
number of its doctors considered best by
their peers.
The institution ranks in the
top third in funding by the National
Institutes of Health and 4th in the
Southeastern United States in revenues from
its licensed intellectual property.
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