Heated post-surgical chemotherapy improves survival for stage IV stomach cancer

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a type of cancer treatment in which surgeons apply heated chemotherapy after surgically removing tumors. This innovative method is used to treat mesothelioma, appendix, colorectal and other types of cancer.

Recently, Brian Badgwell, M.D.,  professor of Surgical Oncology, used HIPEC in a Phase II clinical trial to treat patients with stage IV stomach (gastric) cancer and peritoneal disease.

In this study, conducted from September 2016 to March 2019, 20 patients ranging from age 20 to 75 were treated with five to 11 cycles of chemotherapy and a surgery including HIPEC. The typical life expectancy for patients with stage IV stomach cancer and peritoneal disease is anywhere from six to 11 months, but many study participants are living longer.

“It has only been three and a half years since we started the study, but we’re seeing patients who have continued to be cancer-free, and that’s really exciting,” Badgwell says.

The study’s median overall survival rate from the date of diagnosis of metastatic disease was 2.1 years, or 1.4 years from participation in the study. One-, two- and three-year overall survival rates from the diagnosis of metastatic disease are 90%, 54% and 29%. 

We talked with Badgwell to learn more about the study and HIPEC.

Why did you want to do this HIPEC study?

Current national guidelines do not include HIPEC as a stomach cancer treatment, and there haven’t been any clinical trials for cytoreduction (surgical removal of tumors) and the stomach (gastrectomy) -- and HIPEC conducted in the U.S. But recent studies from across the globe report long-term survival rates of approximately 20% with cytoreduction, gastrectomy and HIPEC. We wanted to establish that model in the U.S.

Tell us more about HIPEC. How is this procedure done?

In this case, we perform HIPEC immediately following the cytoreduction and gastrectomy. So first, we remove the tumors. Then, we remove parts of or all of the stomach, depending on the patient.

Next, we apply heated chemotherapy to the abdomen. This is a 108-degree chemo bath. The heat intensifies the drugs to better fight the cancer. Then, we vigorously rock the patient back and forth while on the operating table for about an hour to distribute the chemotherapy throughout the area. The whole procedure takes anywhere from six to eight hours.

HIPEC is the standard of care for mesothelioma and appendix cancer. But it isn’t performed very often in the U.S. for a few reasons: many patients don’t know about this treatment option, and recovery from the surgery can be hard on the patient.

We’ve been using HIPEC at MD Anderson for about 20 years now. We perform a HIPEC procedure about once a week and use it to treat gastric cancer roughly once a month.

Who should consider HIPEC?

Patients who had a positive response to chemotherapy are more likely to respond well to HIPEC. Patients who are in good health outside of their cancer diagnosis are more likely to have an easier recovery from surgery.

In general, we’ve seen this procedure appeal to patients who are looking for the most aggressive treatment available.

What’s next for HIPEC after this study?

This study will be published this spring. Next, we plan to perform a randomized version of the study. We’re also working on developing ways to apply the chemotherapy that don’t require shaking to distribute it. In short, we’re looking for easier and safer ways to treat stomach cancer.

Refer a patient to MD Anderson online or by calling 1-877-632-6789.