I.P.H.C. & CEDARANIB

Hi there - I need to find out if anyone here has had this procedure, or "Shake N Bake" or Sugarbaker.

We ive in Northampton in England. My dear wife Christine is 58 and has Peritoneal stage 4 - diagnosed in October 08. She had good initial chemo response from carbo/taxol & ca down to 20 from 284. However now it is back up to 173 - she has had two ascites and the hospital are looking to start 2nd round of chemo very soon. This will be carbo/Caelyx & she has also been asked to take part in a trial which includes CEDARANIB as well.

Question one - has anyone on here ever had this drug ?

Question Two - There is a hospital in Salem - Wake Forest - offering an operation called I.P.H.C. They have apparently performed over seven thousand of these and their website claims they can "add years of good quality life to patients for whom there was previously no hope" - end of quote.

Has anyone heard of this hospital, had this operation or been treated by them at all ?

Any information would be VERY helpful as we need to make a decision on treatment early next week. If these people are good we are quite prepared to travel over to Salem to see them.

Thanks eveyone, Roger

By pat813
Posted November 7, 2009 at 4:22 pm
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Roger, Here is a posting from a member that did surgery at Clevleand Clinic
Hope it helps.

Deciding to go for it!
By Kristardh
Posted August 2, 2009 at 7:58 am · 8 replies
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Recommend Print Report post I talked to my doctor on Friday, and we have decided to try "shake and bake" treatment. He will be doing the surgery with a surgical oncologist, whom I will meet next week. After praying about this for a few weeks, I was leaning towards surgery, but I wasn't sure until I heard his voice saying, "I think we should go for it!" My last surgery was September 8, 2008, almost a year ago. And after debulking and 12 rounds of chemo, the cancer is back, but stabilized. I want it GONE! He said this would give me that chance. So, I'm going for it! I'll let you know when the surgery is scheduled and the outcome. I'm actually excited. God bless all of strong women for sharing all your thoughts and feelings!

By Executive
Posted November 7, 2009 at 7:46 pm
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Hi Pat - Is there a way I can find out the outcome on this - Its several months ago now ?
I will look in the treatment forum and try the name in the members list - but should you have a better way of doing this I would be grateful. Thanks for your concern and for taking the time to reply to my post, Sincere regards, Roger.

By lifeisgrand
Posted November 7, 2009 at 11:03 pm
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Roger... here's an article that was in the news today regarding this. Sounds like the results are similar to the current standard of care.

Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in ovarian cancer peritoneal carcinomatosis: systematic review of current results.
Chua TC, Robertson G, Liauw W, Farrell R, Yan TD, Morris DL.

Department of Surgery, St George Hospital, University of New South Wales, Kogarah, Sydney, NSW 2217, Australia. Terence.Chua@unsw.edu.au

BACKGROUND: Advanced and recurrent ovarian cancer results in extensive spread of tumor on the peritoneal surfaces of the abdomen and pelvis. We collectively review studies in the literature that report the efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer peritoneal carcinomatosis.

METHODS: An electronic search of all relevant studies published in peer-reviewed journals before May 2009 was performed on three databases. The quality of each study was independently assessed and classified according to the time point of HIPEC use in various setting of ovarian cancer from the consensus statement of the Peritoneal Surface Oncology Group. Clinical efficacy was synthesized through a narrative review with full tabulation of the results of each included study.

RESULTS: Nineteen studies each of more than ten patients reporting treatment results of HIPEC of patients with both advanced and recurrent ovarian cancer were included and data were extracted. All studies were observational case series. The overall rate of severe perioperative morbidity ranged from 0 to 40% and mortality rate varied from 0 to 10%. The overall median survival following treatment with HIPEC ranged from 22 to 64 months with a median disease-free survival ranging from 10 to 57 months. In patients with optimal cytoreduction, a 5-year survival rate ranging from 12 to 66% could be achieved.

CONCLUSION: Despite the heterogeneity of the studies reviewed, current evidence suggest that complete CRS and HIPEC may be a feasible option with potential benefits that are comparable with the current standard of care. A randomized trial is required to establish the role of HIPEC in ovarian cancer..

By Executive
Posted November 9, 2009 at 6:26 pm
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Hi Lifeisgrand. Thanks as always for your thoughts and the article that is indeed very useful. I have writted to Christine Northampton Oncologist - Jill Stewart - this evening and as you will see, I have included it in the message. Chris has decided on the way forward at the moment - simply based on the fact that the ascites problem needs to be solved NOW - and then other things can fall into place. I will of course keep you informed of how things pan out, and thanks once again from both of us - xx

DETAILS:

Good day Jill.

Today we went to the Royal Marsden in Sutton and saw Prof. Stan Kaye and David Tan on his team. David first went through all Christines disease history and also gave her a physical examination – which he said was fine.

He answered, as you have previously done, our questions and concerns – feeling the best way forward was first a C.T scan as a current baseline, and then Carbo/Caelyx administered in Northampton – with the Marsdens involvement if required - and a further C.T after cycle 3.

Dependent on the result/response – surgery back at the Marsden would then be considered (or to continue on to cycle 6). David also said Christine is unlikely to loose her hair this time.

He said the ICON 6 trial was not applicable because it is based on Carbo/Taxol 2nd line.

Professor Kaye then met Christine and went through his thoughts, as well as also giving her an external examination. He agreed the combination of Carbo/Caelyx was the right way forward – he did say he was somewhat surprised an ascites problem should have occurred so soon after a CT scan that showed very little disease present – and he discussed Christines past Sarcoidosis.

He also agreed a CT scan done now would provide a benchmark for treatment – and he then said he would telephone you and go through his thoughts and to request an immediate CT at Northampton.

Christine and I felt this to be a fair assesment of the situation Jill – but would ask your thoughts on these points.

1)We are aware of a “window” of treatment for maximum possible response – however, could we meet with you, or a member of your team, to discuss the results of the CT scan (and maybe a CA125 test) before chemotherapy commences.

2)Should we avail ourselves of the assay / cell death test professor Ian Cree at Portsmouth offers to affirm which chemo drugs are likely to show best response.

3)Would the HIPEC method of chemotherapy spoken of here still be a possibility should there be a further relapse in the future, or indeed a lack of response to the carbo/caelyx regimin ?

Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in ovarian cancer peritoneal carcinomatosis: systematic review of current results.
Chua TC, Robertson G, Liauw W, Farrell R, Yan TD, Morris DL.

Department of Surgery, St George Hospital, University of New South Wales, Kogarah, Sydney, NSW 2217, Australia. Terence.Chua@unsw.edu.au

BACKGROUND: Advanced and recurrent ovarian cancer results in extensive spread of tumor on the peritoneal surfaces of the abdomen and pelvis. We collectively review studies in the literature that report the efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer peritoneal carcinomatosis.

METHODS: An electronic search of all relevant studies published in peer-reviewed journals before May 2009 was performed on three databases. The quality of each study was independently assessed and classified according to the time point of HIPEC use in various setting of ovarian cancer from the consensus statement of the Peritoneal Surface Oncology Group. Clinical efficacy was synthesized through a narrative review with full tabulation of the results of each included study.

RESULTS: Nineteen studies each of more than ten patients reporting treatment results of HIPEC of patients with both advanced and recurrent ovarian cancer were included and data were extracted. All studies were observational case series. The overall rate of severe perioperative morbidity ranged from 0 to 40% and mortality rate varied from 0 to 10%. The overall median survival following treatment with HIPEC ranged from 22 to 64 months with a median disease-free survival ranging from 10 to 57 months. In patients with optimal cytoreduction, a 5-year survival rate ranging from 12 to 66% could be achieved.

CONCLUSION: Despite the heterogeneity of the studies reviewed, current evidence suggest that complete CRS and HIPEC may be a feasible option with potential benefits that are comparable with the current standard of care. A randomized trial is required to establish the role of HIPEC in ovarian cancer.

As always – thanks for reading this Jill – obviously it's a very difficult time for us both – and of course the decision we make needs to be from the standpoint of covering all possible angles.

Regards, Roger & Christine.

By optimist1125
Posted November 9, 2009 at 11:50 pm
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I had Thermotropic Intraperitoneal Surgery in Jan.2008 in Boston, Mass. This surgery and chemo put me back into remission after my recurrence in May 2005.My intitial diagnosis was in June 2003 and I had 6 cycles of carboplatin and taxol then remission until my recurrence in May 2005.After May 2005 I had 8 cycles of carboplatin and taxetere then Doxil for for 12 cycles with a 3 month break for a bowel obstruction surgery.Then weekly carbo and gemcidibine until an allergic reaction to carbo and I was on weekly gemcidibine until Dec 2007. This surgery was 8 hours and very intense, I came out of surgery and was in ICU from Tues to Fri and went home on the following Monday. I am so glad I had this surgery. It is now Nov. 2009 and I have not been back on chemo yet. Have had some other issues but this has given me almost 2 years chemo free and a wonderful quality of life. This has been the best that I have felt in 6 years.

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