Heated Intraperitoneal Chemotherapy for Locally Advanced Colon Cancer–Restarting the Fire
Mené en Espagne entre 2015 et 2021 sur 184 patients atteints d'un cancer colorectal localement avancé (âge moyen : 61,5 ans ; 60 % d'hommes ; durée médiane de suivi : 36 mois), cet essai randomisé multicentrique de phase III évalue l'efficacité, du point de vue du contrôle local à 3 ans, et la sécurité d'un traitement combinant une chimiothérapie hyperthermique intrapéritonéale par mitomycine C et une cytoréduction complète
Advancement in the treatment of colon cancer continues to change the course of the disease and improve the lives of and survival among patients. Locally advanced colon cancer, T4 or perforated, remains a difficult clinical scenario associated with poor outcomes. Adjuvant chemotherapy is often recommended, but there is limited evidence to support its use in stage II pT4 colon cancer. Despite adequate surgical and systemic treatment, development of peritoneal carcinomatosis can be as high as 25% in this group of patients.Arjona-Sánchez et al conducted a robust randomized clinical trial (HIPECT4) demonstrating that prophylactic mitomycin C (MMC) hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of resection for T4 colon cancer improves local control, particularly in the peritoneum. As PC from colorectal cancer has been shown be less responsive to systemic chemotherapy compared with other sites of metastatic disease, this is an important trial despite their data showing no difference in disease-free and overall survival between the HIPEC and control groups. Importantly, the HIPECT4 trial showed no increased adverse events, including anastomotic leak, with an MMC perfusion at the time of resection. This contrasts with the increased morbidity seen after oxaliplatin-based HIPEC regimens in other studies such as the PRODIGE7 and COLOPEC trials.
JAMA Surgery , éditorial, 2022