Clinical Pharmacology of Platinum-based Hyperthermic Intraperitoneal Chemotherapy

Radboud University Medical Center20 enrolled

Overview

Currently, there is a lack of knowledge on the effect of additional flushing after HIPEC on tumour platinum exposure, systemic platinum exposure and platinum concentration in drain exudate and thereby personal exposure. Therefore the investigators want to perform a study to investigate the effect of flushing after HIPEC on tumour exposure, systemic exposure and on wound exudate concentration.

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is standard care in the treatment of patients with peritoneal carcinomatosis as a result of intra-abdominal cancers. In many (inter)national centres oxaliplatin is used for the primary HIPEC treatment. Although the oxaliplatin dose of 460mg/m2 is widely accepted, the exact procedure of HIPEC differs between institutions and surgeons. Due to a great variety in the volume of the abdominal cavity, platinum concentration in the perfusate might differ between patients. Moreover, there is no consensus about the usefulness of flushing the HIPEC system with crystalloids at the end of oxaliplatin administration. Flushing is predominantly performed with the idea to minimize both systemic exposure of ultrafilterable platinum and personnel exposure to platinum contaminated exudate. On the other hand, HIPEC without flushing might increase effectiveness because intraperitoneal tumour cells are exposed to high concentrations of oxaliplatin for a longer time period. The option of flushing is based on an individual preference of the surgeon. Currently, there is a lack of knowledge on the effect of flushing on tumour platinum exposure, systemic platinum exposure and platinum concentration in drain exudate and thereby personal exposure. Therefore the investigators want to perform a study to investigate the effect of flushing after HIPEC on tumour exposure, systemic exposure and on wound exudate concentration.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Peritoneal Carcinomatosis

Interventions

HIPEC with flushing afterwardsOTHER

flushing with saline fluid after HIPEC

HIPEC without flushing afterwardsOTHER

NO flushing with saline fluid after HIPEC

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Subjects must provide written informed consent prior to performance of study-specific procedures or assessments and must be willing to comply with treatment and follow-up. Note: Informed consent may be obtained prior to start of the specified screening window. Note: Procedures conducted as part of the subject's routine clinical management (e.g., blood count, imaging study) and obtained prior to signing of informed consent may be utilized for screening or baseline purposes. 2. Age ≥ 18 years 3. Confirmed diagnosis of preoperatively identifi ed primary or recurrent peritoneal carcinomatosis (PC) of colorectal origin who are planned for HIPEC treatment with oxaliplatin according to routine clinical care Exclusion Criteria: 1\) Patients who do not achieve a cytoreduction score of CC-0 will be excluded from the study.

Locations (1)

Radboudumc

Nijmegen, Netherlands

Outcomes

Primary Outcomes

change in tissue platinum exposure before and after flushing

Change in tissue platinum exposure of non-tumour peritoneal tissue sample before and after flushing with saline

Time frame: immediately after the oxaliplatin instillate solution is withdrawn from the abdominal cavity and immediately after additional flushing is performed. This takes all place within 1 hour after the start of HIPEC.

Secondary Outcomes

wound exudate platinum concentration

platinum concentration in wound exudate samples will be measured in the drains

Time frame: until day 3 post-HIPEC

systemic exposure of total and unbound platinum

systemic exposure of total and unbound platinum will be measured using 13 blood samples

Time frame: until day 3 post-HIPEC

total and unbound platinum concentration in instillate

total and unbound platinum concentration in instillate will be measured in 3 samples of instillate solution that will be obtained during the HIPEC procedure

Time frame: all samples will be taken within 30 minutes during the HIPEC procedure

Data from ClinicalTrials.gov

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