Adding HIPEC with Mitomycin C Reduces Locoregional Recurrence in Advanced Colorectal Cancer, Shows HIPECT4 Trial in JAMA Surgery

A recent study published in JAMA Surgery suggests that adding hyperthermic intraperitoneal chemotherapy (HIPEC) with mitomycin C to surgery for locally advanced colorectal cancer (CRC) leads to a significant reduction in the risk of locoregional recurrence. The HIPECT4 trial showed a 10% improvement in locoregional control at 3 years, with an absolute benefit of 16% among patients with pathologic (p)T4 disease. While disease-free survival (DFS) and overall survival (OS) did not differ between the two treatment groups, surgery with or without HIPEC led to similar rates of morbidity and toxicity. The HIPEC-mitomycin C regimen also addressed several criticisms of HIPEC with oxaliplatin, and intraoperative HIPEC with mitomycin C did not delay adjuvant chemotherapy because of complications. About 10% of patients with CRC develop peritoneal metastases, which significantly reduce overall survival. Patients often receive adjuvant chemotherapy, which does not eliminate the risk of metastasis. Whether the HIPEC regimen reduces the risk of distant metastasis remains to be seen and will be addressed in the CAIRO6 randomized trial. The findings from the HIPECT4 trial suggest that this HIPEC regimen confers an additional benefit to cytoreductive surgery and thus has important implications for clinical practice.