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12Feb 2018

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The Netherlands Cancer Institute has started a study on HIPEC treatment for gastric cancer

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Surgeon Johanna van Sandick and gastroenterologist Henk Boot from the Netherlands Cancer Institute have started a study on the efficacy of HIPEC treatment for gastric cancer patients with peritoneal metastases. Former minister Edith Schippers conditionally admitted the treatment to the basic package of the Healthcare Insurance Act for a period of 5 years per October 1st 2017. This involves an amount of € 1,855,000.

HIPEC procedures have already been used with promising results in patients with colorectal cancer or ovarian cancer . Now a phase III study has been initiated to explore the efficacy in gastric cancer. As yet, there is no effective treatment for gastric cancer patients with peritoneal metastases. Their life expectancy is extremely poor, four months on average. Palliative systemic chemotherapy is the standard but is not very effective against peritoneal metastases. With the HIPEC treatment, the researchers hope to offer these patients a new treatment.

What is HIPEC?
HIPEC is a treatment in which the abdominal cavity is infused  with heated chemotherapy to kill the remaining cancer cells after the visible peritoneal metastases have been removed. The peritoneum lines the inside of the abdominal cavity and is a common site for shed gastric cancer cells to nestle into and grow. The HIPEC treatment is combined with a resection of the gastric cancer itself. Reported studies from Asia on this treatment are almost invariably positive. But these data are not necessarily translatable to the Western patient with gastric cancer.

Phase I study: Is it feasible?
First, a literature search was done to select the appropriate cytotoxic drugs for intraperitoneal use in gastric cancer patients. Oxaliplatin and docetaxel are both effective against gastric cancer when given via intravenous infusion. Johanna van Sandick: "Subsequently, in a phase I study, we have investigated whether the HIPEC treatment - with these two agents - can be performed safely in gastric cancer patients with peritoneal metastases. Also, in this first study, the dosage of the intraperitoneal chemotherapy was studied in combination with the gastric cancer resection. The outcome of this study is that HIPEC in gastric cancer patients is safe and feasible, provided that the peritoneal metastases are not too extensive, the gastric cancer itself is resectable, and that there is no disease progression during the chemotherapy that is given prior to the operation. Furthermore, strict protocols have been developed for the intensive postoperative care of these patients."

Current study: Does it improve survival?
Now the research has gone one step further. The question in the current study is whether the HIPEC treatment is effective in improving the survival of this patient group. It is a randomized study, i.e. patients who meet the study criteria will be randomly allocated to the experimental treatment (operation with HIPEC) or the current standard treatment in the Netherlands (palliative systemic chemotherapy). A total of 106 patients will be necessary to answer the study question on the efficacy of the HIPEC treatment. The results are expected in the year 2022.

Conditional admission
A treatment was conditionally admitted for the first time in 2012. By conditionally admitting treatments and medicines to the insurance package, patients gain access to these promising forms of care, and there is an insight into the effectiveness and cost-effectiveness of this care. When the period of conditional admission is over, a decision is made on actual admission to the insurance package.

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