Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)

PIPAC is pressurized intraperitoneal aerosol chemotherapy. It is a new method of giving chemotherapy to patients with advanced abdominal cancer in which chemotherapy is given directly into the abdominal cavity.

Routinely, chemotherapy (cancer directed therapy) is administered intravenously (through the veins) as a drip. Intra-peritoneal chemotherapy is given directly into the abdominal cavity in patients who have cancer spread to the peritoneum that is the lining of the abdominal cavity and its organs.

How does PIPAC work?

In PIPAC, a chemotherapy vapor is generated using a special device called ‘Capnopen’. This procedure is performed through laparoscopy. In laparoscopic surgery, the pressure in the abdominal cavity is raised. The combined effect of this increased pressure and vaporized chemotherapy, increases the drug concentration in the cancerous tissue. A very small dose of chemotherapy is used leading to lesser side effects. Recent studies have shown that this form of chemotherapy delivery can be as effective as intravenous chemotherapy.

What are the benefits of PIPAC?

It is a simple procedure for which the patient has to be in the hospital for one or two days only. The side effects are minimal and the recovery is fast. It has shown to be effective when systemic chemotherapy has stopped working or in patients who cannot tolerate systemic chemotherapy. Multiple sessions or  PIPAC can be given at intervals of 6 weeks each. 1/10 the dose is used to produce the same effect as systemic chemotherapy. PIPAC does not interfere with routine chemotherapy and both can be given together to produce a better effect.

Which patients benefit from PIPAC?

Currently, PIPAC is used for patients who have peritoneal tumor deposits arising from ovarian cancer, colon cancer, stomach cancer, appendix cancer and some rare cancers of the peritoneum. Patients who have fluid build up in the peritoneal cavity from any cancer that does not respond to chemotherapy can benefit from this treatment. PIPAC is given to patients who have received chemotherapy before and usually more than 1 type of chemotherapy.

Can PIPAC cure cancer?

PIPAC is currently used for controlling symptoms and reducing the disease burden. In some cases the tumor can disappear completely or may reduce drastically and surgical removal of the remaining tumor can be performed. These patients may experience a prolonged survival.

Can all patients benefit from PIPAC?

Patients who are bed ridden and cannot eat, those who are malnourished or have massive ascites do not benefit from PIPAC. Sometimes there are adhesions between the intestines and abdominal wall due to which laparoscopy is not possible and hence these patients cannot receive PIPAC.

What are the side effects of PIPAC?

Some of the common side effects of PIPAC are abdominal pain, nausea, alteration in the liver and kidney functions. Most of these side effects resolve within a few days. More serious side effects usually do not occur with PIPAC.

Is PIPAC an experimental therapy?

First we should go back to what an experiment means- an experiment is a scientific procedure undertaken to determine something. The effects of PIPAC are known. It has been used in human patients and has been effective. This is in certain conditions mentioned above- when chemotherapy has stopped working or the fluid does not reduce with chemotherapy. In these cases, PIPAC is not experimental.

There are other situations in which the results are not known- like is PIPAC an alternative to chemotherapy? In these situations, it is experimental and its effect is been studied in clinical trials and other experimental studies.

Can PIPAC be used outside clinical trials?

Yes,  PIPAC can be used outside clinical trials.

What is the difference between HIPEC and PIPAC?

HIPEC is a single treatment usually given during open surgery and higher doses of chemotherapy drugs are used in it. PIPAC is given laparoscopically and multiple sessions are possible, doses of drugs used are lower.

Which is better? HIPEC or PIPAC?

Right now both have different uses. HIPEC is used along with radical surgery that comprises of complete tumor removal (cytoreductive surgery). It can cure certain patients.

PIPAC is used for patients who cannot undergo HIPEC. Its role is palliative. Some times PIPAC is used to shrink the tumor before cytoreductive surgery and HIPEC.

Cytoeductive surgery and HIPEC require a greater expertise to perform compared to PIPAC.

Which is the best place to take this treatment?

These procedures are best performed by a surgeon specializing in peritoneal cancer management; in institutes that are experienced in the management of peritoneal cancers.