A clinical trial has found that using hyperthermic intraperitoneal chemotherapy (HIPEC) with mitomycin C alongside surgery for locally advanced colorectal cancer (CRC) has significantly reduced the risk of locoregional recurrence. At the end of three years, patients who underwent cytoreduction plus HIPEC with mitomycin C had a 10% increase in locoregional control compared to those who underwent cytoreduction alone. The absolute benefit increased to 16% among patients with pathologic (p)T4 disease. Neither disease-free survival (DFS) nor overall survival (OS) varied between the two treatment groups.
The HIPEC-mitomycin C Regimen
Alvaro Arjona-Sánchez, MD, PhD, of University Hospital Reina Sofia in Córdoba, Spain, and co-authors reported that surgery with or without HIPEC led to similar rates of morbidity and toxicity. The HIPEC-mitomycin C regimen addressed several criticisms of HIPEC with oxaliplatin. According to an accompanying editorial, the HIPECT4 trial showed no increase in adverse events or toxicity. Sara K. Daniel, MD, and Byrne Lee, MD, of Stanford University School of Medicine in California, added that intraoperative HIPEC with mitomycin C did not delay adjuvant chemotherapy because of complications. A similar proportion of patients in both groups started adjuvant treatment within 12 weeks of surgery.
Whether the HIPEC regimen reduces the risk of distant metastasis remains to be seen and will be addressed in the CAIRO6 randomized trial. About 10% of patients with CRC develop peritoneal metastases, which significantly reduce overall survival. Multiple clinical trials have previously evaluated the efficacy of cytoreductive surgery with adjuvant HIPEC, but the results have been mixed. The HIPECT4 trial is the first to investigate the specific role of HIPEC with mitomycin C in reducing the risk of peritoneal relapse after resection in patients with locally advanced colorectal cancer. These findings support the need for different strategies to prevent peritoneal relapse in patients at high risk.
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