Leading the Charge in Advanced Cancer Care Through Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

October 17, 2024

Chemotherapy is an effective cancer treatment that destroys fast-growing cancer cells in the body. However, traditional chemotherapy targets the entire body, and its side effects can be widespread. 

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a form of chemotherapy that directly targets tumors in the abdominal cavity (the area of the belly that contains the stomach, liver, and other organs). It’s typically used for cancer that has spread (or metastasized) into the abdominal cavity from another part of the body. Surgeons remove tumors then use HIPEC to circulate heated chemotherapy drugs in the abdominal cavity, killing cancer cells and helping patients live longer. 

At University Medical Center, the flagship cancer hospital of LSU LCMC Health Cancer Center, we’re proud to offer this innovative cancer treatment to patients in the Gulf South region. Our program treats patients with a range of cancers, including cancers of the appendix, stomach, ovaries, and colon and rectum. For ovarian cancer, our program is the first, most robust, and longest running in South Louisiana. 

HIPEC utilizes some of the most effective approaches to destroying cancer cells, offering an option for patients who have advanced and hard-to-treat cancers. 

A Heated Approach to Cancer Treatment 

The term hyperthermic intraperitoneal chemotherapy may be a mouthful, but it represents an impressive and unique approach to cancer treatment. 

“Hyperthermic” means hot or heated. Similar to how a fever is the body's way of attacking viruses and bacteria that cause infections, heat is cytotoxic and kills cancer cells. By heating chemotherapy drugs, they can more effectively kill cancer cells. During HIPEC, chemo drugs are heated to 108 degrees Fahrenheit. 

According to Dr. Amelia Jernigan, Director of Gynecologic Oncology at LSU Health New Orleans and Medical Director of Cancer Services at University Medical Center, “There's some thought that the heat itself is like a fever and involves an immuno-like reaction, that could change the way antigen-presenting cells work, T-cells are activated, and cytokines are released.” 

There are other benefits to the heat, such as managing resistance to chemotherapy, which is when treatment stops working due to molecular changes that make cancer cells insensitive to a specific drug. “At the molecular level, heat shock proteins and other things allow the chemo to overcome chemo resistance,” Dr. Jernigan explains. 

The Power of Precision: How HIPEC Attacks Cancer Cells With Fewer Side Effects 

The “intraperitoneal” part of HIPEC refers to how the chemo goes directly into the abdominal cavity, targeting just that area of the body. Traditional chemotherapy, on the other hand, is systemic, meaning it travels through the bloodstream and affects cells all over the body. 

“HIPEC can be extremely targeted and give really high doses of chemotherapy directly to the surface of the abdomen,” says Dr. Jernigan. “That's important because most of that will not end up getting systemically absorbed.” 

By avoiding systemic absorption, patients experience fewer side effects. If small doses of chemotherapy do manage to seep out, the body can safely absorb and expel it. After HIPEC, side effects are often limited to nausea, diarrhea, constipation, and bloating. 

HIPEC also addresses another problem of traditional chemotherapy. Thanks to the protection of the peritoneum barrier, systemic chemotherapy can’t typically reach the abdominal cavity. Using HIPEC, chemotherapy drugs are sent directly where they need to go. 

According to Dr. Kevin Sullivan, Surgical Oncologist and Assistant Professor in the Department of Surgery, Division of Surgical Oncology at LSU Health New Orleans, “This is a way of delivering the chemo directly to that area where it doesn't have to go through all the other detours.” 

By using higher doses of cancer-killing chemotherapy in targeted locations, HIPEC is a win-win for cancer treatment. 

Finally, in traditional chemotherapy, treatment comes in cycles. For example, a patient might get three cycles of chemotherapy, or one round every three weeks. After a certain number of rounds, chemo might pause while the patient undergoes surgery for tumor removal.  

While this pause is essential for recovery, Dr. Jernigan explains that it can be problematic. “One of the concerns is that tumors may potentially start to grow back,” she says. 

HIPEC, however, is done in one session. As Dr. Sullivan explains, “HIPEC is usually paired with a surgery to remove all of the tumor. That's called cytoreduction. Then it’s given right after that to clean up any residual cells or any tumor that's left over.” 

“Giving chemo at the time of surgery means that we're not backsliding because we had to omit chemo to get them through surgery,” says Dr. Jernigan. 

The Future of HIPEC Cancer Treatment 

University Medical Center’s HIPEC program serves a critical need in the Gulf South region. “It takes a lot of investment and time to set up a HIPEC program and get patients through it,” explains Dr. Jernigan. “By offering this option, patients in our region can access lifesaving treatment close to home.” 

Clinical trials also offer opportunities for patients to access the latest advancements in cancer treatment, including new approaches to HIPEC. For example, the HOTT clinical trial is studying heated intraperitoneal chemotherapy followed by a medication called niraparib for ovarian, primary peritoneal, and fallopian tube cancer. 

Both Dr. Jernigan and Dr. Sullivan are optimistic about the future of HIPEC addressing more types of cancer in even more effective ways. For instance, Dr. Sullivan says things like repeated administrations and different modalities are both promising approaches as research continues. 

As the LSU LCMC Health Cancer Center and University Medical Center continue to innovate and expand its HIPEC program, patients in the Gulf South have more hope than ever before. With dedicated physicians like Dr. Jernigan and Dr. Sullivan leading the charge, and groundbreaking clinical trials pushing the boundaries of cancer treatment, the future is bright. Advancements in HIPEC not only offer new possibilities for current patients but also pave the way for future generations to benefit from lifesaving care.