Indian cancer centres need to team up for clinical trials with Pressurized Intra-Peritoneal Aerosolized Chemotherapy (PIPAC) technology to prove it is the best option when chemotherapy fails for ovarian cancer cases, said Dr Roopesh N, Consultant & Surgeon, Gynecologic Oncology, Cytecare Cancer Hospital.

PIPAC which is performed using CapnoPen was launched in India in May 2017. This procedure has demonstrated positive outcomes with regard to improvement in quality of life in patients who are resistant to and those who are not candidates for chemotherapy in the relapsed setting. There is adequate clinical trial data to confirm its efficacy based on European studies at this point. It has also been used over 3,000 applications in over 100 centres worldwide including USA, Europe, Australia, Singapore and South America, Dr. Roopesh told Pharmabiz.

In the last 8 months, Indian hospitals including Tata Memorial and Cytecare among other cancer centres account for 12 surgeons who have undergone training in PIPAC and so far 7 procedures have been performed in the country. Dr Roopesh too has been certified on PIPAC at The Advanced Surgery Training Centre National University Hospital, Singapore under the guidance of Dr. Prof M A Reymond, the inventor of PIPAC.

The simple one-hour laparoscopic procedure with CapnoPen is minimally invasive, enabling shorter hospital stay, faster return to normal activity, limited surgical scars, reduced blood loss during surgery, less pain following surgery and reduced risk of infection. So far patients have not had any reported issues, he added.

Although age is not a criteria for selecting a patient for the CapnoPen procedure, the key factor is that she should be clinically fit after not responding to chemotherapy or when major lines of chemotherapy have been exhausted during relapse. The decision for selecting a patient for PIPAC shall be taken in a Multi-disciplinary Tumour Board meeting which is manned by a panel of oncologists who are surgeons, physicians, radiologists and pathologists.

Therefore in India PIPAC being a nascent technology, CapnoPen procedure needs clinical trial data from India to prove its favourable survival outcomes. It is time, we work towards the feasibility of this study on Indian ovarian cancer relapse cases. Suitable patients from high volume cancer centres need to be accessed for clinical trials. There is need for more training for oncology surgeons and increased awareness on PIPAC so that appropriate patients not suitable for conventional chemotherapy would benefit from this treatment, stated Dr. Roopesh.

There has been a growing interest in management of peritoneal surface malignancies by several leading Indian surgeons. As an initial innovation, about 25 years ago, the concept of Intra-peritoneal chemotherapy came into picture. Although IP chemotherapy showed a favourable survival outcome, it did not take off as expected due to reasons like catheter related complications, Then came heated IP chemotherapy (HIPEC) which is a single shot procedure and recognised therapy for recurrent ovarian cancers. A recent major clinical trial has shown significant survival benefit with HIPEC and has rekindled many towards embracing this procedure for interval cytoreduction cases. But for Platinum resistant and refractory ovarian cancers as well as recurrent cancers failing on chemotherapy, where quality of life is the major issue, PIPAC showed fabulous results. Hence there has been a growing interest in the novel therapy. In most hospitals one PIPAC procedure costs 2 lakh to the patient all inclusive and HIPEC which is a single sitting is about Rs.6 to Rs.12 lakh, he said.