Switching Chemotherapy Drugs During Repeat CRS-HIPEC Surgery
- May 27
- 2 min read
Mangieri, C.W., Levine, E.A. ASO Author Reflections: Evaluating HIPEC Switch for Repeat CRS–HIPEC, Time to End a Common Practice?. Ann Surg Oncol 30, 392–393 (2023). https://doi.org/10.1245/s10434-022-12483-3
Researchers at Wake Forest Baptist Health studied whether changing the chemotherapy drug used during a second CRS-HIPEC procedure helps patients live longer or stay cancer-free longer. CRS-HIPEC is a specialized treatment for cancers that have spread inside the abdomen. It combines surgery to remove visible tumors with heated chemotherapy delivered directly into the abdominal cavity.
Why Was This Study Done?
When patients need a second CRS-HIPEC surgery because their cancer has returned, many surgeons switch to a different chemotherapy drug during the heated chemotherapy portion of treatment. The idea behind this practice is that cancer cells may become resistant to the first drug over time. However, there has been little research showing whether switching drugs actually improves outcomes.
What Did the Researchers Study?
The team reviewed records from 101 patients who underwent repeat CRS-HIPEC surgery. Most patients had appendiceal (appendix) cancer, while a smaller number had colorectal cancer.
Researchers compared:
Patients whose HIPEC chemotherapy drug was switched during the second surgery
Patients who received the same chemotherapy drug again
The two most common drugs used were:
Mitomycin C
Oxaliplatin
The study looked at:
Overall survival (how long patients lived)
Disease-free survival (how long patients remained cancer-free after treatment)
What Were the Results?
The researchers found that switching chemotherapy drugs during repeat CRS-HIPEC did not improve overall survival or disease-free survival for most patients.
Key findings included:
Patients who switched drugs lived about the same length of time as those who did not switch drugs
Five-year survival rates were similar between the two groups
There was no clear evidence that changing drugs reduced the risk of cancer recurrence
In a smaller subgroup of patients with colorectal cancer, switching drugs was actually linked to shorter disease-free survival. However, because this subgroup included only a small number of patients, researchers caution that more study is needed before drawing firm conclusions.
What Does This Mean for Patients?
This study suggests that routinely changing the chemotherapy drug during a second CRS-HIPEC surgery may not provide additional benefit. The findings challenge a common surgical practice that has not previously been well studied.
Importantly:
The study does not prove that switching drugs is harmful
Decisions about CRS-HIPEC treatment should still be individualized
More research involving multiple treatment centers is needed
Why Is This Important?
Repeat CRS-HIPEC can help selected patients with abdominal cancers live longer and maintain quality of life. Understanding which parts of treatment truly improve outcomes helps doctors make evidence-based decisions and avoid unnecessary changes in care.
This research provides some of the strongest evidence to date that changing HIPEC chemotherapy drugs during repeat surgery may not improve patient outcomes.
Source: “Switching Perfusion Agents for Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy, Surgical Dogma or Evidence-Based Practice?”
