PIPAC versus HIPEC: cisplatin spatial distribution and diffusion in a swine model

Area of Science:

• Oncology
• Surgical Oncology
• Pharmacokinetics

Background:

• Peritoneal carcinomatosis requires effective intraperitoneal chemotherapy delivery.
• Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel approach.
• PIPAC aims for homogeneous drug distribution compared to hyperthermic intraperitoneal chemotherapy (HIPEC).

Purpose of the Study:

• To compare cisplatin peritoneal distribution and pharmacokinetics between HIPEC and PIPAC.
• To evaluate drug delivery efficacy in a healthy swine model.

Main Methods:

• Two groups of eight pigs underwent either HIPEC (cisplatin 70 mg/m², 43°C, 60 min) or PIPAC (cisplatin 7.5 mg/m², 30 min).
• Peritoneal biopsies were collected for cartography.
• Tissular and plasmatic cisplatin concentrations were analyzed.

Main Results:

• Cisplatin distribution was heterogeneous in both groups, with higher concentrations near delivery sites.
• Median total platinum peritoneal concentration was higher in the HIPEC group (18.0 μg/g) than PIPAC (4.3 μg/g).
• PIPAC showed a 2.2 times better drug uptake yield despite lower concentrations, with plasma levels below toxicity thresholds for both.

Conclusions:

• HIPEC achieved higher cisplatin peritoneal uptake than PIPAC at clinical doses in this swine model.
• Both techniques exhibited heterogeneous spatial drug distribution.
• PIPAC demonstrated a superior intraperitoneal drug uptake yield when considering the dose ratio.