NIPEC, or normothermic intraperitoneal chemotherapy, is an emerging protocol for the treatment of malignant peritoneal mesothelioma. Still in the early stages of research, it involves multiple cycles of a room-temperature chemotherapy wash delivered directly into the abdominal cavity. NIPEC has been shown to improve survival rates, with one study reporting a 5-year survival rate of 75% for patients who received the protocol in combination with additional treatments.[1]
What Is NIPEC?
NIPEC is a novel way of administering chemotherapy, the common cancer treatment that uses cytotoxic drugs to destroy cells in tumors. For patients diagnosed with malignant peritoneal mesothelioma and other peritoneal cancers, physicians have found THAT applying chemotherapy directly into the intraperitoneal cavity – rather than systemically — delivers markedly better outcomes without the troubling side effects typical of traditional delivery of the drugs.
For the last several years, that intraperitoneal delivery of chemotherapy has been delivered in combination with cytoreductive surgery in a process known as HIPEC, or hyperthermic intraperitoneal chemotherapy. The drug solution is heated and administered directly into the open surgical site, where it is allowed to bathe the area for approximately 90 minutes.
NIPEC, or normothermic intraperitoneal chemotherapy (NIPEC), is another method of delivering chemotherapy intraperitoneally, which has proven extremely effective when combined with HIPEC and surgery. In NIPEC, non-heated chemotherapy is delivered into the abdomen via a peritoneal port. It allows for long-term, minimally invasive, repeat dosing in an outpatient setting.[2]
Is NIPEC Used in Combination with Surgery?
NIPEC is generally used either in combination with intravenous and/or oral chemotherapy or as a supplement to cytoreductive surgery with HIPEC. It is designed to prevent the return of the cancer and to extend patient survival.[3]
What Does NIPEC Treat?
NIPEC has been used as a supplemental treatment following cytoreductive surgery for patients diagnosed with a variety of peritoneal metastases after physicians found that the single application of chemotherapy delivered with HIPEC and the lack of a consistent cytotoxic effect on cancer cells failed to maintain cancer control within the abdomen and pelvis. These failures have been specifically found in patients diagnosed with ovarian cancer, gastric cancer, and malignant peritoneal mesothelioma as a supplement to the CRS-HIPEC procedure.[4]
How Does NIPEC Improve Upon Traditional Chemotherapy and CRS-HIPEC?
NIPEC offers hope of a significant improvement in eradicating peritoneal mesothelioma tumors. Compared to traditional, systemic chemotherapy, which travels throughout the entire body, NIPEC’s direct delivery into the area impacted by the cancer cells eliminates significant side effects. NIPEC offers the same targeted approach as HIPEC, delivering chemotherapy directly to the affected area and minimizing damage to healthy tissues.
Beyond the improvements over traditional chemotherapy, studies have shown that adding multiple cycles of NIPEC treatment as a supplemental treatment cytoreductive surgery with heated intraperitoneal chemotherapy delivered a statistically significant increase in survival.[5]
How Successful Is NIPEC?
In a study published in the European Journal of Surgical Oncology, noted peritoneal mesothelioma researcher Dr. Paul H. Sugarbaker found that following cytoreductive surgery and HIPEC with long-term intraperitoneal chemotherapy as an adjuvant normothermic intraperitoneal chemotherapy (NIPEC) delivered a five-year survival that was 31% better than that of patients treated with cytoreductive surgery and HIPEC alone.[6]
How Is NIPEC Treatment Performed?
NIPEC treatment begins with the placement of an access port near the rib cage. This port will be inserted before you begin treatment, usually at the same time as the cytoreductive surgery and HIPEC treatment. It will remain in place, allowing delivery of the chemotherapy medication directly into the peritoneal cavity over the course of your treatment. Though you may see or feel the port, it should not interfere with your day-to-day activities.
Approximately four to six weeks after your surgery it will be time for your treatment to begin. At your outpatient appointment, your medical team will ask you to lie down so they can access a raised chamber on top of the port. A needle will be inserted through your skin into the port’s self-sealing disc, and then the needle will be taped in place and covered with a bandage. A catheter attached to the needle will allow the room-temperature chemotherapy medication to be delivered directly into your peritoneal space. You will go through this procedure on a schedule prescribed by your mesothelioma specialist. Once you have completed your course of treatment, the port will be removed.[7]
Does NIPEC Improve Survival Times?
Though NIPEC is a relatively new addition to peritoneal mesothelioma treatment, it has already delivered impressive results for patients diagnosed with a variety of peritoneal cancers:
- In a study published in 2020, six patients who were treated with three to six one-week-long cycles of NIPEC following cytoreductive surgery with HIPEC found that four of the patients were free of disease at 8, 13, 18, and 19 years after the procedure, while two died of their disease 15 years after treatment. The researchers concluded that the procedure delivered long-term benefits, though more studies were needed.[8]
- A 20-year study of peritoneal mesothelioma patients who’d undergone cytoreductive surgery with HIPEC found that those whose treatment was followed with NIPEC experienced improved maintenance and near-complete response.[4]
Are There Side Effects or Risks of the NIPEC Treatment?
NIPEC can cause side effects, though they’re generally more infrequent and much less troubling than those that come with systemic chemotherapy.
Still, side effects can occur. Potential risks include suppression of bone marrow function, which can lead to reduced red blood cell counts and a weakened immune response. Patients may experience gastrointestinal issues such as decreased appetite, diarrhea, nausea, and vomiting, and some patients report abdominal pressure, bloating, and frequent sensations of needing to urinate.
More serious complications can develop, such as kidney failure, port-site infections, or sepsis. Some patients may experience an increased breathing rate during treatment. The severity and occurrence of these side effects vary significantly between patients and are impacted by factors including advanced age or poor overall health. Your physician is the best person to determine your risk of side effects based on these variables, so it’s essential that you speak frankly with them about your personal risk factors and potential complications before beginning treatment.
The Future of NIPEC
NIPEC is a promising treatment for malignant peritoneal mesothelioma, and physicians are increasingly investigating its use in combination with cytoreductive surgery with HIPEC. If you’ve been diagnosed with malignant peritoneal mesothelioma, seek treatment at a specialized cancer treatment center whose staff includes physicians experienced in the treatment of this rare and challenging form of cancer.
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