Dr. Lewin on the Addition of HIPEC to Interval Cytoreductive Surgery in Ovarian Cancer

Sharyn Lewin, MD, FACS, assistant clinical professor of Obstetrics and Gynecology, Icahn School of Medicine, The Mount Sinai Hospital, gynecologic oncologist and medical director of the Department of Gynecologic Oncology, Holy Name Medical Center, discusses addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery in patients with newly diagnosed advanced-stage ovarian cancer who were receiving neoadjuvant chemotherapy.

In the randomized phase 3 clinical trial published in the New England Journal of Medicine, investigators examined the role of HIPEC in women who with newly diagnosed disease who had neoadjuvant chemotherapy and then had an interval cytoreduction, says Lewin. The women were randomized to HIPEC at the time of the interval cytoreduction followed by further chemotherapy. Those treated with HIPEC experienced a significantly longer median overall survival than those who did not receive HIPEC, notes Lewin. Specifically, at a median follow-up of 4.7 years, 62% of those who underwent surgery alone versus 50% of those who underwent surgery plus HIPEC died (HR, 0.67; 95% CI, 0.48-0.94; P =.02). The median overall survival was 33.9 months in the surgery arm and 45.7 months in the surgery plus HIPEC arm.

The results of the study were impressive, particularly when stratifying out all other variables, notes Lewin. It is an important modality that requires surgical expertise and collaboration with other surgical oncologists, adds Lewin. Given the impressive improvement in survival, it is something that should be offered—especially in the interval setting when women have received neoadjuvant chemotherapy, concludes Lewin.