Of the two, aerosol: scientists have found a way to increase the effectiveness of chemotherapy

Russian specialists have created equipment for innovative PIPAC therapy, aerosol pressure chemotherapy. The method allows the drug to be delivered directly to the tumor foci, providing a high concentration of the drug with minimal toxicity to the body. Import substitution and the creation of domestic devices will make high-tech care more accessible, the doctors said. Who is shown the advanced treatment and what is the uniqueness of the development — in the material of Izvestia.

What is PIPAC therapy?

The method of intra-abdominal pressure aerosol chemotherapy (PIPAC therapy) has been optimized at the Sechenov University Faculty Surgery Clinic No. 2. It is used mainly in patients with stages III–IV of stomach cancer. It consists in spraying a chemotherapy drug inside the abdominal cavity. Thus, the drug (fine suspension) penetrates better into tumor foci, does not cause serious complications and is well tolerated, since a small dose is used — 10% of the systemic dose. This therapy effectively reduces the spread of metastases and reduces ascites, the accumulation of fluid in the abdominal cavity.

A high-tech injector is used to perform the procedure. It is not always available, and its cost reaches one million rubles.

Photo: Sechenov University

— To ensure that neither clinicians nor patients are dependent on supplies and high cost, our staff decided to replace the injector with a modified cartridge pistol. The new device has been pre-tested on laboratory animals. The clinical results did not differ from those if we had used the original device," said Tatiana Khorobrykh, director of the Sechenov University Faculty of Surgery Clinic No. 2.

The updated device is several times cheaper than its counterpart and, most importantly, it more thoroughly irrigates the peritoneum with a chemotherapy drug, the doctors emphasized. At the moment, it is patented and its application is carried out according to special protocols.

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Which patients are shown PIPAC therapy

PIPAC is used as a "last resort therapy" to improve the patient's quality of life, but not always. Sometimes intra-abdominal pressure aerosol chemotherapy is prescribed as a preoperative step to reduce the tumor.

— This is a modern and effective method of treating peritoneal carcinomatosis (malignant lesion of the peritoneum, when metastases spread over its surface and affect internal organs. — Ed.) with advanced stomach cancer. Carcinomatosis significantly worsens the prognosis, and intra-abdominal aerosol chemotherapy is often the only way to help the most severe patients. Unfortunately, this method is not widely used in our country and is available only in federal medical centers," said Tatiana Khorobrykh.

A significant reduction in the cost of PIPAC therapy equipment and localization of its production will make this procedure more accessible to patients, including in the regions, she concluded.

Photo: Global Look Press/IMAGO

This is a relatively new technology, but it looks promising for a narrow group of patients, Maxim Kotov, market expert at NTI Helsnet and oncologist at the N.N. Petrov National Research Medical Center of Oncology, told Izvestia. The accumulated data show an acceptable level of safety, the possibility of multiple procedures and antitumor activity.

— The most logical niche for PIPAC today is patients with peritoneal carcinomatosis of stomach cancer, colorectal cancer, ovarian cancer and some other solid tumors, in which radical treatment is impossible, and systemic chemotherapy has already exhausted its possibilities or does not control the disease effectively enough. Also, in some cases, this technology can be used as a neoadjuvant strategy in order to reduce the volume of the disease and then switch to radical treatment," the oncologist said.

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Prospects for a new device

PIPAC therapy itself is not a "new chemotherapy", but a new form of delivery of already known drugs. Its key advantage is the creation of high concentrations in the foci of peritoneal carcinomatosis with minimal systemic toxicity, Albert Rizvanov, head of the Personalized Medicine Center of Excellence at Kazan (Volga Region) Federal University, told Izvestia.

— Therefore, the idea of reducing the cost and technological localization of equipment looks quite rational: in oncology, it is often not so much the method as its cost and logistics that becomes a barrier. If the modified device really provides a comparable size of aerosol particles, uniformity of distribution and safety when working under pressure, then this can significantly expand the availability of the method in regional centers, the expert said.

Photo: IZVESTIA/Yulia Mayorova

PIPAC therapy is indicated for a relatively narrow group of patients: approximately 5-10% of all patients with advanced gastric cancer. These are patients without serious complications and with a stable general condition, said the expert of NTI "Helsnet", a biologist, oncologist and bioinformatician, founder of biomedtech startups BioAlg Corp. and OncoUnite Dmitry Chebanov.

"The method has been actively studied for more than a decade and has proven its safety, but definitive data on the impact on overall survival are still accumulating," he said.

It will take several more years of clinical research to be fully incorporated into international standards, the specialist emphasized.