PIPAC Nab-pac for Stomach, Pancreas, Breast and Ovarian Cancer

Over 85% of women with ovarian cancer (OC) will develop a peritoneal recurrence after initial therapy. The prognosis of patients with recurrent disease is poor, with a median survival ranging from 12 to 24 months. Most of these patients ultimately develop platinum resistant disease (PROC). Current systemic therapy results in a very modest improvement of progression free and overall survival. The addition of locoregional, intraperitoneal (IP) therapy may improve disease control in recurrent OC. Recently, pressurized intraperitoneal aerosol therapy (PIPAC) was added to the therapeutic arsenal. This novel technique allows repeated laparoscopy aided aerosol delivery of anticancer drugs to the peritoneal cavity. Abraxane (nab-pac, Celgene) is a novel 130 nm, albumin-bound (nab) nanoparticle formulation of paclitaxel which has noteworthy single-agent activity and a favourable toxicity profile when used systemically in PROC. A recent phase I study showed a significant pharmacokinetic advantage after IP instillation of nab-pac in patients with peritoneal carcinomatosis from ovarian or gastro-intestinal (GI) origin.

In phase I of this study, dose escalation will be combined with pharmacokinetic/pharmacodynamic modelling which incorporates, in addition to plasma, tumour tissue, and peritoneal drug concentrations, biomarkers of toxicity and efficacy.

Inclusion criteria

• Phase I study: patients with advanced carcinomatosis from ovarian, breast, gastric, or pancreatic origin. No alternative systemic treatment options are available.
• Age over 18 years
• Adequate performance status (Karnofsky index > 60%)
• Absence of intestinal or urinary obstruction
• Limited size of the majority of peritoneal tumor implants (< 5 mm)
• Absent or limited ascites
• Ability to understand the proposed treatment protocol and provide informed consent
• Expected life expectancy more than 6 months
• Laboratory data

• Serum creatinine ≤ 1.5 mg/dl or a calculated GFR (CKD-EPI) ≥ 60 mL/min/1.73 m²
• Serum total bilirubin ≤ 1.5 mg/dl, except for known Gilbert's disease
• Platelet count > 100.000/µl
• Hemoglobin > 9g/dl
• Neutrophil granulocytes > 1.500/ml
• No major blood coagulation disorders. Parameters within normal range.
• Absence of alcohol and/or drug abuse
• No other concurrent malignant disease
• Written informed consent

Exclusion criteria

• Pregnancy or breast feeding. Women who can become pregnant must ensure effective contraception.
• Active bacterial, viral or fungal infection
• Active gastro-duodenal ulcer
• Parenchymal liver disease (any stage cirrhosis)
• Uncontrolled diabetes mellitus
• Psychiatric pathology affecting comprehension and judgement faculty
• General or local (abdominal) contra-indications for laparoscopic surgery
• Documented intolerance or allergy to paclitaxel
• Patients who receive other taxane therapy until three weeks before the first experimental treatment