Colorectal cancer afflicts over 150,000 Americans each year with over 52,000 deaths. While there has been an overall decline, the incidence in people under 55 is rapidly rising.
The treatment of colorectal cancer has moved to the combination of chemotherapy and surgery with some people receiving preoperative chemotherapy. A novel approach developed by Dr. Paul Sugarbaker in Washington DC instills heated chemotherapy directly into the abdomen at the time of surgery. This is known as HIPEC (Heated Intraperitoneal Chemotherapy) and has become increasingly popular worldwide for patients with advanced disease.
However, when French investigators compared the outcome of colon cancer patients who received HIPEC using intraperitoneal Oxaliplatin to patients who had surgery alone without HIPEC, they found no difference – suggesting that HIPEC didn’t work.
To explain this finding, we collaborated with Dr. Sugarbaker and found that the HIPEC patients were receiving the same drugs into the abdomen that they had received intravenously. We then used our laboratory to study drug resistance to Oxaliplatin in colon cancer specimens from patients who had received Oxaliplatin intravenous chemotherapy.
In a paper we published in 2021 (Nagourney R et al European Journal of Surgical Oncology, April 2021), we used our Ex Vivo Analysis (EVA/PCD) to show that Oxaliplatin drug resistance would affect the results of HIPEC if Oxaliplatin was used for the intraperitoneal drug and identified Mitomycin-C – a very different form of chemotherapy – as a more effective choice for HIPEC administration.
Now, a report by Spanish investigators has confirmed our findings. As reported at the European Society of Medical Oncology meeting in 2022 (Arjona-Sanchez, A Proc ESMO, 2022), a study of 184 patients from 17 different hospitals that compared the outcome for HIPEC using Mitomycin-C to surgery alone in colon cancer showed improved survival for HIPEC with Mitomycin-C. While all the patients received intravenous Oxaliplatin chemotherapy, it was the group that received Mitomycin-C HIPEC that had the best survival rates.
These results are entirely consistent with our prior observation: that the intraperitoneal abdominal therapy should not use the same drug as the intravenous therapy.
It is gratifying to realize that the colon cancer tissue studies that we conducted in our laboratory were able to identify a life-saving strategy that can now be applied to improve colon cancer patient outcomes.
Once again, the laboratory teaches us that cancer patients do best when the right drugs are administered. Every patient deserves the right drug, the first time, every time.