New chemotherapy approach for late-stage cancers

By Jessica Saenz

Chemotherapy is a drug treatment used to kill cancer cells, and it can be delivered in several ways. Most often, chemotherapy is delivered to the entire body by vein or orally as a pill. Though chemotherapy can be highly effective at treating cancer, it can lead to some uncomfortable side effects.

Cancer experts are exploring ways to target chemotherapy and deliver it to the site of the tumor to improve its effectiveness and reduce some of the side effects from the treatment. One new approach, called hyperthermic intraperitoneal chemotherapy (HIPEC), delivers heated liquid chemotherapy to the abdomen where it can target certain cancers that have spread in the abdominal cavity.

Travis Grotz, M.D., a Mayo Clinic surgical oncologist, explains how HIPEC works and how it can help patients with certain late-stage cancers.

What is HIPEC?

Before chemotherapy treatment, surgery often is used to remove as much of the cancer tumor as possible. Chemotherapy is then used to kill cancer cells that might be left behind. HIPEC follows the same concept, though it can sometimes be used alone.

Immediately after surgical removal of a tumor, warm chemotherapy liquid is infused into the peritoneum, the sac that encases abdominal organs. Heating the chemotherapy drugs allows it to penetrate tissues more deeply and kill more cancer cells. And because the chemotherapy drugs won't circulate through the rest of the body, they can be used in higher doses, which improves effectiveness.

"It's like if you have a dirty countertop or table. You want to clean off all the dirt and grime. The surgical part of HIPEC removes any tumor the surgeon can see," says Dr. Grotz. "But if you want to eat on that countertop, you want it clean. So you sterilize and get rid of the bacteria. HIPEC is like a chemical to sterilize the microscopic stuff the surgeon can't see." Combining surgery with HIPEC can increase the chance of cure and prevent cancer from returning.

Who is a candidate for HIPEC?

Because HIPEC is delivered to the peritoneum, Dr. Grotz says it is currently only used for people with cancers that are confined to the abdomen. "We know for sure, based on studies and data, that HIPEC works well for cancers of the colon, appendix, ovaries, stomach and cancer of the lining of the peritoneum, called mesothelioma," he says.

Though other organs, like the pancreas, gallbladder and small intestine, are located in the abdomen, Dr. Grotz says there isn't enough data to support whether or not HIPEC can be effective for cancers of these organs.

Dr. Grotz says that when deciding if someone is a candidate for HIPEC treatment, health care professionals also must consider the type of tumor, its genetic makeup and the likelihood that they can remove all or most of the tumor. "Some tumors grow more slowly, are more sensitive to chemotherapy and less invasive. In some aggressive tumors, like stomach or colon cancer, the success rate might be lower."

It's also important to consider a patient's overall health. "Some chemotherapy drugs we use, depending on the type of cancer, can be hard on the body. Overall health is important to take into consideration as this is a major abdominal cancer surgery and patients need to be in good health, active and have good nutrition to recover well," he says.

To better minimize risk and improve the chance of success, Dr. Grotz says HIPEC should be performed by a multidisciplinary team with significant HIPEC experience who can collaborate on the many different areas of care involved. "It's a very complex surgery. There's a direct volume-to-outcome relationship in terms of patient outcomes. With most surgeries, we do 20 or 30 of them, and surgeons are competent and comfortable with it. But research suggests that, for this surgery, it's closer to 120–150 procedures before the outcomes are ideal."

What can patients expect after HIPEC?

HIPEC therapy is usually done during surgery to remove cancer, and Dr. Grotz says surgery is often the most difficult part of recovery, though this can vary by patient.

The addition of HIPEC also might add fatigue to the surgery recovery process. "It's going to take several months for them to get their stamina level up. It wears people out," says Dr. Grotz, adding that gastrointestinal side effects also can occur. "Your bowels are bathed in chemotherapy, so people can experience irritable bowel symptoms, like gassiness, abdominal cramping, intermittent nausea or diarrhea. It's generally mild and resolves over a few months."

Though HIPEC is a one-time procedure, and patients can benefit from not having recurring chemotherapy treatment, Dr. Grotz says recovery from surgery and HIPEC can sometimes take a mental toll on patients. "I think one of the things people struggle with is the several-month period of fatigue and not feeling the greatest. It can lead to some depression. It's hard to feel kind of 'blah' for a couple of months, so I think recognizing that and getting support from your family and friends is helpful."

When cancer spreads in the abdomen, HIPEC can destroy more cancer cells and help patients live longer, with fewer side effects of traditional chemotherapy.

If you're considering HIPEC as a treatment for your cancer, Dr. Grotz emphasizes finding a cancer center that specializes in the procedure but, more importantly, one that can aim for the best result for your case.

"There's always a little bit of unknown, which I think is sometimes hard for patients," Dr. Grotz says. "But at the end of the day, our goal is to get all the cancer out and improve quality of life and recovery."

Watch Dr. Grotz discuss HIPEC and how it can help people with late-stage cancer in this "Mayo Clinic Q&A" podcast video:

Learn more

Find a HIPEC clinical trial at Mayo Clinic and join the Cancer: Managing Symptoms support group on Mayo Clinic Connect.

Read these articles:

• "Mayo Clinic Q&A podcast: Hot chemotherapy for late-stage cancers"
• "Ovarian cancer is hard to detect, but new and better treatments are improving survival"
• "Alternative, innovative method of delivering chemotherapy shows promising results, retrospective review says"

Also watch these videos:

• "HIPEC treatment for ovarian cancer: Mayo Clinic Radio"
• "HIPEC Surgery for Metastatic GI Cancer - Mayo Clinic