Peritoneal carcinomatosis in colorectal cancer
In recent years, the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) has become a much-discussed option for treating peritoneal metastases from colorectal cancer. The PRODIGE 7 study, led by Prof. Dr. François Quenet, a surgical oncologist specialising in peritoneal disease, is a phase III trial whose data lead us to reconsider the role of HIPEC with oxaliplatin in this context.
What exactly did PRODIGE 7 analyze?
A phase III, multicenter, randomized trial conducted in 17 specialized centers in France, with 265 patients aged 18–70 years with colorectal cancer and resectable peritoneal metastases (Peritoneal Cancer Index ≤25 and good general condition).
All patients underwent cytoreductive surgery seeking macroscopically complete resection and received systemic chemotherapy before and/or after surgery; the comparison was between adding HIPEC with oxaliplatin versus not adding it.
Study results
Treatment of peritoneal carcinomatosis using only systemic chemotherapy (without cytoreductive surgery) has a median survival of only 16 months. The study showed that survival was three times higher in cases of complete cytoreduction surgery.
Good quality of life was also observed in patients included in PRODIGE 7, notably reducing the rate of late postoperative complications. As the press headlined the day after the presentation of the study at ASCO in Chicago: "Less is More!".
What are the implications for patients?
PRODIGE 7 shows that, when complete cytoreductive surgery is achieved in expert centers and systemic chemotherapy is combined, HIPEC with oxaliplatin does not provide more survival and does carry more risk of complications.
These data reinforce the idea that the pillar of treatment with curative intent for peritoneal carcinomatosis of colorectal origin is radical surgery in the hands of specialized teams, within a multidisciplinary approach and with very careful patient selection.
Dr. François Quenet's role in the trial
Prof. Dr. François Quenet led the PRODIGE 7 trial and presented its results at the 2018 ASCO congress. The trial provides randomised data on when HIPEC with oxaliplatin adds benefit and when it can be avoided in patients with peritoneal metastases of colorectal origin.