Hyperthermic intraperitoneal chemotherapy beneficial in recurrent ovarian cancer

Administering hyperthermic intraperitoneal chemotherapy (HIPEC) during cytoreductive surgery for recurrent ovarian cancer helps prolong overall survival, according to the results of the phase III open-label CHIPOR trial.

CHIPOR was conducted at 31 sites across France, Belgium, Spain, and Canada and included 415 female patients with first relapse of epithelial ovarian cancer at least 6 months after completing platinum-based chemotherapy. All patients had a WHO performance status of <2 and were amenable to complete cytoreductive surgery.

The patients were randomly assigned to receive HIPEC (cisplatin 75 mg/m² in 2 L/m² of serum at 41 °C for 60 minutes; n=207) or not (n=208) during the surgical procedure. The primary endpoint was overall survival, analysed on an intention-to-treat basis in all patients who underwent randomization.

Over a median follow-up of 6.2 years, 268 (65 percent) patients died, including 126 (61 percent) in the HIPEC group and 142 (68 percent) in the no-HIPEC group. The median overall survival was 54.3 months (95 percent confidence interval [CI], 41.9–61.7) with HIPEC vs 45.8 months (95 percent CI, 38.9–54.2) without HIPEC. In addition, HIPEC correlated with a 27-percent reduction in the risk of progression or death (stratified hazard ratio 0.73, 95 percent CI, 0.56–0.96; p=0.024).

In terms of safety, grade 3 or worse adverse events (AEs) within 60 days after surgery occurred in 102 (49 percent) patients in the HIPEC group and in 56 (27 percent) in the no-HIPEC group. Anaemia (23 percent vs 14 percent) was the most common AE, followed by hepatotoxicity (11 percent vs 9 percent), electrolyte disturbance (14 percent vs 1 percent), and renal failure (10 percent vs 1 percent). A total of three patients died within 60 days of surgery, all in the no-HIPEC group.

The findings suggest that platinum-based HIPEC may be considered when treating patients with late first relapse of high-grade serous or high-grade endometrioid ovarian cancer amenable to complete cytoreductive surgery in order to extend overall survival.