Hyperthermic intraperitoneal chemotherapy (HIPEC) provides an important treatment option that can improve survival for some patients with advanced peritoneal cancer. Managing this disease — and determining whether and when to use HIPEC — requires an experienced, coordinated team of specialists.
Medical oncologist Stacey Cohen, MD and surgical oncologist Harveshp Mogal, MD lead the multidisciplinary HIPEC clinic at Fred Hutchinson Cancer Center. Fred Hutch was recently created by the merger of Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center and serves as UW Medicine’s adult cancer program.
“Developing a treatment plan involves highly complex clinical decision-making,” says Dr. Cohen. “Peritoneal cancer does not usually respond well to conventional chemotherapy, so we employ a combination of treatments — including HIPEC.”
HIPEC is a two-step process. The first step involves surgical removal of all visible tumors (cytoreduction). Next, the surgeon delivers chemotherapy heated to about 106 degrees Fahrenheit into the abdominal cavity. The solution, which circulates for one to two hours, is intended to destroy any remaining cancer cells.
HIPEC is not new, says Dr. Mogal. It emerged in the 1990s as a treatment for pseudomyxoma peritonei. This rare type of metastatic peritoneal cancer develops in the appendix and secretes mucin (mucus) into the abdominal cavity. Over the past decade, indications for HIPEC have expanded to other metastatic peritoneal cancers starting in the colon, rectum, appendix and small intestine. It's also an option for other cancers, such as:
HIPEC requires a seamless, coordinated approach, so the multidisciplinary HIPEC team meets weekly to discuss each patient’s case. “We evaluate patients over the course of their care to assess their progress,” says Dr. Cohen.
The team brings together physicians and technicians with expertise in abdominal cancer. Support staff who work with patients before and after surgery also participate in team meetings. Members of the HIPEC multidisciplinary team include:
Cytoreduction with HIPEC is a long, complex operation that can last up to 12 hours and requires significant experience and expertise. Selecting patients for the procedure is based on their previous response to chemotherapy and their cancer type, among other factors.
“When we evaluate patients for this procedure, we also consider their age, medical conditions and overall health,” says Dr. Mogal. “Our goal is to select patients who can tolerate surgery and bounce back. The aim is to balance long-term survival with a good quality of life.”
HIPEC is just one aspect of treatment for advanced peritoneal cancer. The multidisciplinary team formulates an overall roadmap for each patient’s care and revisits the plan routinely. The roadmap may include:
“In some cases, we find out that a patient’s tumor may not respond well to HIPEC and adjust their treatment plan,” says Dr. Mogal. “Having a multidisciplinary team allows us to make these dynamic, nuanced decisions so we can provide the best possible care.”
An early referral allows Dr. Cohen, Dr. Mogal and their team to coordinate with referring oncologists about a treatment plan and offer a wider range of options. This extra time also helps patients decide if HIPEC is right for them and is something they really want to do.
Once a plan is in place, patients who live outside the Seattle area can receive chemotherapy closer to home. “We monitor their progress remotely. If needed, the patient comes to Fred Hutch for surgery,” says Dr. Cohen.
The multidisciplinary HIPEC team evaluates several new patients each week and performs more than 50 cytoreduction and HIPEC procedures per year. “If patients are not eligible for HIPEC, we may offer other types of chemotherapy or a clinical trial,” says Dr. Cohen.
Cytoreduction surgery is almost always covered by insurance. But some companies consider the HIPEC component of the procedure investigational.
“We advocate on behalf of patients and submit supporting documentation,” says Dr. Mogal. “If HIPEC is not covered, patients may still benefit from cytoreduction alone. We go back to the multidisciplinary team and revise the treatment plan based on the patient’s insurance coverage and personal preferences.”
Fred Hutch’s HIPEC team provides expert multi-disciplinary evaluation and individualized treatment options including HIPEC, for patients with metastatic peritoneal cancer.
For patient referrals, contact: