Optimizing Chemotherapy for Peritoneal Metastases with Precision Medicine

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• Challenges in Chemotherapy Selection
• Moving Beyond Anatomical Classification
• The Role of HIPEC in Treatment
• Integrating Systemic and Regional Therapy
• The Importance of Surgical Precision
• Value of a Medical Second Opinion
• Full Transcript

Challenges in Chemotherapy Selection

Selecting the correct chemotherapy for metastatic peritoneal cancer presents a significant clinical challenge. Dr. Paul Sugarbaker, MD, states that choosing the optimal chemotherapy agent requires the most work currently. The standard approach often fails a large portion of patients.

Dr. Sugarbaker finds it distressing that only about half of all patients respond to Mitomycin C, a common chemotherapy drug used during HIPEC. This means the treatment's effectiveness is essentially a coin toss for many individuals. This low response rate underscores the urgent need for more personalized treatment strategies.

Moving Beyond Anatomical Classification

The current paradigm for chemotherapy selection is largely based on the anatomic location of the primary cancer. Dr. Paul Sugarbaker, MD, explains that for colorectal cancer, physicians typically choose Mitomycin C. This organ-based classification system is outdated and often ineffective for personalized care.

Dr. Paul Sugarbaker, MD, emphasizes the critical goal of moving toward a molecular and genetic classification of tumors. This shift is a continuous topic of discussion with oncologists. Personalized medicine must use molecular markers in both the tumor and the patient to guide chemotherapy selection, not just the cancer's anatomical origin.

The Role of HIPEC in Treatment

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a vital component of treating peritoneal metastases. The procedure involves bathing the abdominal cavity with heated chemotherapy for about 90 minutes. The heat is designed to augment the chemotherapy's cancer-killing effects.

However, Dr. Paul Sugarbaker, MD, cautions that if the chemotherapy agent is not correctly selected, many patients receive only a "90-minute washing of their abdomen" without clinical benefit. This highlights that the drug choice is as important as the delivery method itself. The interview with Dr. Anton Titov, MD, explores how to maximize the efficacy of this limited treatment window.

Integrating Systemic and Regional Therapy

A modern approach to peritoneal metastatic cancer involves combining different chemotherapy routes. Dr. Paul Sugarbaker, MD, advocates for using multiple chemotherapy agents during HIPEC. This includes medications given directly into the peritoneal space.

He also stresses the importance of chemotherapy medications given intravenously. These systemic drugs circulate to the abdominal organs and are augmented by the heat within the peritoneal cavity during HIPEC. Dr. Sugarbaker believes a combination of intravenous and intraperitoneal chemotherapy is necessary to achieve a maximal response against the cancer.

The Importance of Surgical Precision

The surgical component of treatment is overwhelmingly the most critical factor for success. Dr. Paul Sugarbaker, MD, estimates that 90% of the treatment's benefit comes from the precision surgery, known as cytoreductive surgery or peritonectomy. This complex procedure involves meticulously removing all visible tumor deposits from the abdomen.

In contrast, he attributes only about 10% of the overall benefit to the HIPEC procedure itself. This underscores that precision surgery forms the foundation of curative treatment for diseases like metastatic colon cancer, ovarian cancer, and gastric cancer. The chemotherapy then targets any microscopic residual disease.

Value of a Medical Second Opinion

Seeking a medical second opinion is crucial for patients diagnosed with advanced abdominal cancer. Dr. Anton Titov, MD, discusses how a second opinion can clarify a diagnosis of colon cancer or ovarian cancer with peritoneal metastases. It also confirms whether a curative treatment approach is a viable possibility.

This process helps patients and their families select the best precision medicine treatment for stage 4 cancer. A consultation with a specialized center can provide access to advanced treatments like cytoreductive surgery and HIPEC. Dr. Paul Sugarbaker, MD, is a leading expert in this field, making a second opinion with him or his peers highly valuable.

Full Transcript

Dr. Anton Titov, MD: Renowned Harvard-trained American cancer surgeon talks about challenges to select correct chemotherapy medication. How to use Hyperthermic Intraperitoneal Chemotherapy (HIPEC). "Only half of cancer patients are going to respond to Mitomycin C chemotherapy medication."

Molecular characterization of metastatic peritoneal cancer tumor and the patient hold key roles in better chemotherapy selection. We have to move from anatomical organ-based cancer classification to molecular and genetic classification of tumors.

Personalized chemotherapy selection for metastatic peritoneal cancer. Precision medicine and precision surgery.

Peritoneal metastatic cancer treatment: precision medicine and precision surgery. Leading cancer surgeon Dr. Paul Sugarbaker on personalized medicine to treat peritoneal metastatic cancer. Each patient should have personalized chemotherapy chosen for his or her cancer treatment.

90% efficacy is in cytoreductive surgery part of cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Colon cancer, gastric cancer, ovarian cancer spread in the abdomen and peritoneal cavity.

Peritoneal metastases in advanced stage 4 colon cancer treatment by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) [hot chemo bath, heated chemotherapy]. Medical second opinion clarifies colon cancer or ovarian cancer diagnosis. Medical second opinion confirms that cure is possible in metastatic colon cancer.

Intraperitoneal chemotherapy treatment for advanced stage 4 cancer with metastatic lesions in the abdomen. Medical second opinion helps to select a precision medicine treatment for stage 4 ovarian cancer or stage 4 colon cancer or metastatic stage 4 gastric cancer.

Get medical second opinion on advanced cancer with peritoneal metastases. Best peritoneal metastatic advanced cancer treatment by surgical operation and regional chemotherapy.

Video interview with Dr. Paul Sugarbaker. Leading expert in peritoneal metastatic cancer treatment (cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), hot chemo bath, heated chemotherapy.

Personalized chemotherapy selection for metastatic peritoneal cancer - precision medicine and precision surgery. Chemotherapy to treat peritoneal metastatic cancer: precision medicine and precision surgery.

Dr. Paul Sugarbaker, MD: I would say that choosing the correct chemotherapy medication requires the most work at this point in time. We need to work more on the selection of the optimal chemotherapy agent for a particular patient.

Dr. Anton Titov, MD: At this point in time we tend to choose cancer treatment medications based on the anatomic location of the cancer. For colorectal cancer we usually use mitomycin C or mitomycin C and doxorubicin. But is that the best chemotherapy medication for a particular patient? It probably is not.

This is a continuous topic of discussion that I have had with a lot of oncologists. The goal is to move from anatomical classification of tumors and into the molecular markers in the tumor and in the patient.

We have to use personalized medicine for the patient to select chemotherapy. Not just the anatomical classification of cancers. That seems to be what you are talking about.

Dr. Paul Sugarbaker, MD: Absolutely. It is distressing that we know that using mitomycin C maybe helps 50% of the patients.

Only half of cancer patients are going to respond to that chemotherapy medication, even though it is heated during Hyperthermic Intraperitoneal Chemotherapy (HIPEC) treatment. A lot of peritoneal metastatic cancer patients will not benefit from this chemotherapy medication. All patients are getting is a 90-minute washing of their abdomen.

Dr. Anton Titov, MD: Only 50% of patients benefit from this chemotherapy medication during Hyperthermic Intraperitoneal Chemotherapy (HIPEC)? That is a toss of a coin?

Dr. Paul Sugarbaker, MD: That's correct! That's correct! We now need to begin using multiple chemotherapy agents for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to treat abdominal cancer metastases.

Medications given into the peritoneal space that are augmented by heat. We have to use chemotherapy medications that are given in the bloodstream; these are augmented by heat.

Because these chemotherapy medications will circulate to the abdominal organs. Chemotherapy to treat peritoneal metastatic cancer will be augmented by the heat within the peritoneal space during Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

Dr. Anton Titov, MD: We need now to be thinking about a combination of intravenous and intraperitoneal chemotherapy agents to get a maximal response from peritoneal cancer tumor. Because we have 90 minutes to treat peritoneal metastatic cancer during Hyperthermic Intraperitoneal Chemotherapy (HIPEC). We have to be very accurate in what we're doing.

Sometimes we do not select chemotherapy medications correctly; a lot of patients are going to be treated with chemotherapy and not benefit from cancer treatment.

Luckily, probably the most meaningful treatment method of all aspects of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is surgery. It is the peritonectomy and the visceral resection that is the most important part of Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

I would say 90% of it is in the surgical part of peritoneal cancer treatment. 10% of benefit for patients is in the Hyperthermic Intraperitoneal Chemotherapy (HIPEC) [hot chemo bath, heated chemotherapy].

Dr. Anton Titov, MD: It is a combination of precision medicine and precision surgery to treat peritoneal metastases from colorectal cancer, ovarian cancer or gastric cancer?

Dr. Paul Sugarbaker, MD: Absolutely, yes. Hot chemo bath, heated chemotherapy.

Dr. Anton Titov, MD: Personalized chemotherapy selection for metastatic peritoneal cancer. Precision medicine and precision surgery must be used for each cancer patient today.