Pharmacokinetics of cisplatin during open and minimally-invasive secondary cytoreductive surgery plus HIPEC in women with platinum-sensitive recurrent ovarian cancer: a prospective study.

Abstract

OBJECTIVE:

Evidences from animal models seem to suggest that minimally invasive surgery may enhance cisplatin diffusion when the drug is administered in the context of post-operative hyperthermic intraperitoneal chemotherapy (HIPEC). The present study evaluates the cisplatin pharmacokinetic profile in a prospective series of women with platinum sensitive recurrent epithelial ovarian cancer treated with open secondary cytoreductive surgery (O-SCS) or minimally-invasive secondary cytoreductive surgery (MI-SCS).

METHODS:

Cisplatin levels were assessed at 0, 20, 40, 60, and 120 minutes in: 1) blood samples, 2) peritoneal perfusate, and 3) peritoneal biopsies at the end of HIPEC. Median Cmax has been used to identify women with high and low drug levels. Progression-free survival (PFS) was calculated as the time elapsed between SCS+HIPEC and secondary recurrence or last follow-up visit.

RESULTS:

Nine (45.0%) women received MI-SCS, and 11 (55.0%) O-SCS. At 60 minutes, median cisplatin Cmax in peritoneal tissue was higher in patients treated with MI-SCS compared to O-SCS (Cmax=8.262 μg/mL vs. Cmax=4.057 μg/mL). Furthermore, median cisplatin plasma Cmax was higher in patients treated with MI-SCS compared to O-SCS (Cmax=0.511 vs. Cmax=0.254 μg/mL; p-value=0.012) at 120 minutes. With a median follow-up time of 24 months, women with higher cisplatin peritoneal Cmax showed a longer PFS compared to women with low cisplatin peritoneal levels (2-years PFS=70% vs. 35%; p-value=0.054).

CONCLUSIONS:

We demonstrate for the first time that minimally invasive route enhances cisplatin peritoneal tissue uptake during HIPEC, further evaluations are needed to confirm the correlation between peritoneal cisplatin levels after HIPEC and survival.

TRIAL REGISTRATION:

ClinicalTrials.gov Identifier: NCT01539785.

• Authors: Marco Petrillo, Massimo Zucchetti, Stefano Cianci, Lavinia Morosi, Carlo Ronsini, Andrea Colombo, Maurizio D'Incalci, Giovanni Scambia, Anna Fagotti
• Journal: Journal of gynecologic oncology (J Gynecol Oncol) Vol. 30 Issue 4 Pg. e59 (Jul 2019) ISSN: 2005-0399 [Electronic] Korea (South)
• PMID: 31074245 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2019. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

Chemical References

• Antineoplastic Agents
• Cisplatin

Topics

• Adult
• Aged
• Antineoplastic Agents (administration & dosage, blood, pharmacokinetics)
• Carcinoma, Ovarian Epithelial (pathology, therapy)
• Cisplatin (administration & dosage, blood, pharmacokinetics)
• Cytoreduction Surgical Procedures (adverse effects, methods)
• Drug Resistance, Neoplasm (drug effects)
• Female
• Humans
• Hyperthermia, Induced (methods)
• Middle Aged
• Ovarian Neoplasms (pathology, therapy)
• Prospective Studies