A new clinical trial at The University of New Mexico Comprehensive Cancer Center is applying hyperthermic intraperitoneal chemotherapy (HIPEC), a proven surgical technique, to ovarian cancer.
A Deadly Cancer
Ovarian cancer is one of the more deadly cancers. According to the American Cancer Society, 120 people in New Mexico will be diagnosed with ovarian cancer in 2024. But 70 New Mexicans will die of the disease, and statistics from the National Cancer Institute show a 5-year survival rate of about 50.9%.
Ovarian cancer has vague signs and symptoms, and no screening tests can catch it in its early stages. By the time ovarian cancer is usually found, tumors have spread throughout the peritoneum, which is the membrane that lines the abdomen and contains digestive, reproductive, and other organs.
Removing the many tumors and clearing any remaining cancer cells in the peritoneum is a complex procedure. Conventional chemotherapy treatment, which sends drugs through the bloodstream, can affect many cells in the body and not just the tumor cells. Regional therapy, such as HIPEC, can kill cancer cells in a certain area of the body.
Direct Contact
“Delivering chemotherapy directly into the abdomen allows us to give high doses of chemotherapy onto the surfaces of the abdominal organs, while avoiding high doses of chemotherapy circulating in the bloodstream,” Alissa Greenbaum, MD, says.
Greenbaum leads the HIPEC program at UNM Comprehensive Cancer Center. She is the only HIPEC-trained surgeon in New Mexico and received special training for the procedure at the Rutgers Cancer Institute of New Jersey.
Delivering chemotherapy directly into the abdomen allows us to give high doses of chemotherapy onto the surfaces of the abdominal organs, while avoiding high doses of chemotherapy circulating in the bloodstream.
Surgery with HIPEC averages seven hours but ranges from two to 17 hours. It comprises two steps. First, the surgeon removes all visible tumors from the peritoneum. Then — while still in the operating room — the surgeon delivers chemotherapy drugs directly into the peritoneum. The drugs are heated to 108 degrees Fahrenheit, and the surgeon bathes the abdominal organs with them for 90 minutes.
Surgery with HIPEC is the standard treatment for stage IV appendix cancer. It is also used to treat colorectal cancer, mesothelioma, stomach cancer, and cancers that have spread from other regions into the peritoneum.
“Many studies are showing that when combined with other cancer treatments, HIPEC can help patients to live longer,” Greenbaum says.
But as with any treatment, surgery with HIPEC has risks, and patients often spend a week or more in the hospital to recover. The most common side effect is sluggish digestion, and the intestines can take days or weeks to return to normal.
Still, HIPEC may help New Mexicans who receive an ovarian cancer diagnosis.
A Clinical Trial to Help Ovarian Cancer Patients
“HIPEC could be ideal to use as a component of ovarian cancer treatment,” says Carolyn Muller, MD, the Associate Director for Clinical Research at UNM Cancer Center. She also leads the Gynecologic Oncology team at UNM Cancer Center.
“The majority of [ovarian cancer] patients are diagnosed with stage III or stage IV disease,” Muller says. “The bulk of the ovarian cancer is spread through the entire peritoneal or belly cavity. Some global and ongoing studies suggest HIPEC may help achieve remission and possibly result in longer progression-free and overall survival.”
Greenbaum and Muller cite a 2018 study published in the New England Journal of Medicine. The study showed that ovarian cancer patients who received surgery with HIPEC lived an average of 12 months longer than those who received the standard surgery.
HIPEC could be ideal to use as a component of ovarian cancer treatment. The majority of [ovarian cancer] patients are diagnosed with stage III or stage IV disease. The bulk of the ovarian cancer is spread through the entire peritoneal or belly cavity. Some global and ongoing studies suggest HIPEC may help achieve remission and possibly result in longer progression-free and overall survival.
Treatment for most people with ovarian cancer starts with three or four cycles of chemotherapy. Called neoadjuvant chemotherapy, this initial chemotherapy shrinks their tumors.
Patients then undergo surgery to remove the remaining tumors. If the tumors shrink with the neoadjuvant chemotherapy, the abdominal organs can often be spared during surgery. If the tumors do not respond, however, affected organs may have to be removed.
The clinical trial at UNM Cancer Center will compare the standard surgery to surgery with HIPEC. The study will look at whether people who receive surgery with HIPEC live longer than those who receive the standard surgery.
The clinical trial will also study the effects of maintenance therapy after surgery. And it will compare whether the disease returns and how long it takes to return.
The UNM Cancer Center is one of 23 sites throughout the country to offer this clinical trial. Few centers have a team of HIPEC-trained oncology surgeons, gynecology oncologists, medical oncologists, anesthesiologists, dietitians, pharmacists, and advanced practice providers to provide the comprehensive care that patients need.
Not every ovarian cancer patient will quality for the clinical trial. Still, Muller says that anyone who has an ovarian cancer diagnosis and who needs chemotherapy before surgery should consider joining.
Greenbaum adds, “Not every patient will qualify for the procedure, but we would rather capture more patients who could benefit than miss them completely.”
About the Clinical Trial
The clinical trial, “Heated Intraperitoneal Chemotherapy Followed by Niraparib for Ovarian, Primary Peritoneal and Fallopian Tube Cancer (HOTT),” is open to patients at the UNM Comprehensive Cancer Center. Learn more about the clinical trial at https://clinicaltrials.gov/study/NCT05659381.
UNM Comprehensive Cancer Center
The University of New Mexico Comprehensive Cancer Center is the Official Cancer Center of New Mexico and the only National Cancer Institute-designated Cancer Center in a 500-mile radius.
Its more than 136 board-certified oncology specialty physicians include cancer surgeons in every specialty (abdominal, thoracic, bone and soft tissue, neurosurgery, genitourinary, gynecology, and head and neck cancers), adult and pediatric hematologists/medical oncologists, gynecologic oncologists, and radiation oncologists. They, along with more than 600 other cancer healthcare professionals (nurses, pharmacists, nutritionists, navigators, psychologists and social workers), provide treatment to 65% of New Mexico’s cancer patients from all across the state and partner with community health systems statewide to provide cancer care closer to home. They treated almost 15,000 patients in more than 100,000 ambulatory clinic visits in addition to in-patient hospitalizations at UNM Hospital.
A total of nearly 1,855 patients participated in cancer clinical trials testing new cancer treatments that include tests of novel cancer prevention strategies and cancer genome sequencing.
The more than 123 cancer research scientists affiliated with the UNMCCC were awarded $38.2 million in federal and private grants and contracts for cancer research projects. Since 2015, they have published nearly 1000 manuscripts, and promoting economic development, they filed 136 new patents and launched 10 new biotechnology start-up companies.
Finally, the physicians, scientists and staff have provided education and training experiences to more than 500 high school, undergraduate, graduate, and postdoctoral fellowship students in cancer research and cancer health care delivery.
