Feasibility and safety profile of high-dose oxaliplatin-based PIPAC (120mg/m2) in the treatment of advanced peritoneal metastatic disease: MINOS real-life multicenter study

Introduction Oxaliplatin (Ox) is one of the recommended agents in Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) that benefitted of several phase I trials. Based on these data, the dose of 120mg/m 2 was suggested by an expert consensus for fit patients with peritoneal metastases (PM) of gastrointestinal cancers. The aim of the current study is to determine the real-life feasibility and safety profile of this regimen. Material and methods This retrospective study included all patients treated with PIPAC-Ox 120mg/m 2 in six referral centers specialized in PM. The patients were assessed for all potential toxicities associated to high dose oxaliplatin. Adverse events were expressed with the use of CTCAE for medical complications and Clavien-Dindo for surgical complications. Logistic regression and multivariate analysis were performed. Results 259 PIPAC procedures were performed in 91 patients (53 male) diagnosed with unresectable PM of various origins; most patients (n=62) having colorectal PM. Concomitant IV 5FU was performed in 70 patients. All patients underwent the first PIPAC-Ox 120mg/m 2 , and 44 patients (48.3%) had ≥ 3 PIPAC. Abdominal pain was the most frequent grade III toxicity at the first PIPAC-Ox (n=34) while 30 patients routinely received continuous IV opioids. Nausea-vomiting and ascites infection were the others grade III toxicity observed at PIPAC 1, one in each case respectively. After PIPAC 3, RECIST partial/stable response in 68.2%; PRGS 1-2 in 77.3% and negative cytology in 50% of patients. Conclusions High-dose PIPAC-Ox is feasible and safe. Local and histological response are well identified. However abdominal pain remains a main concern and continuous IV protocols should be considered routinely.