Safety and efficacy of cisplatin and nab-paclitaxel pressurised intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal carcinomatosis: Nab-PIPAC phase 1b study.

BACKGROUND: Platinum and taxanes are backbone chemotherapy in multiple solid tumours. We aimed to investigate the safety, tolerability, and pharmacokinetics of nab-paclitaxel and cisplatin administered by pressurised intraperitoneal aerosol chemotherapy (PIPAC). METHODS: Nab-PIPAC is a phase 1b trial investigating PIPAC administration of cisplatin at 10.5 mg/m2 and escalating dose of nab-paclitaxel with a 3 + 3 design (7.5, 15, 25, 37.5, 52.5 and 70 mg/m2). PIPAC was repeated at 4-6 weeks intervals for up to three courses to estimate the maximum tolerated dose (MTD). FINDINGS: We enrolled 22 patients with peritoneal carcinomatosis, of whom 18 received at least one PIPAC: 6 ovarian, 9 gastric and 3 pancreatic cancers. Four patients (ovarian cancer) did not receive PIPAC due to bowel obstruction (n = 1) or no access to peritoneal cavity (n = 3). Median age was 67 years (43-81). In total, 45 PIPAC procedures were administered and 12 of 18 (67%) patients completed three PIPAC cycles. There was no dose limiting toxicity. The most common side effect was abdominal pain. One patient had grade 3 treatment related adverse event: bladder lesion requiring surgical reintervention. Median progression-free survival was 3.5 months and median overall survival was 9.4 months. Five patients with gastrointestinal cancer survived more than one year (3 gastric and 2 pancreatic). Pharmacokinetic analyses showed good linearity between nab-paclitaxel dose and the AUC0-last (R2 = 0.90). INTERPRETATION: The combination of nab-paclitaxel and cisplatin administered by PIPAC was safe and well tolerated in patients with peritoneal carcinomatosis. Further investigation of this combination is warranted. FUNDING: The study was supported by la bourse jeune chercheur des Hopitaux Universitaires de Geneve (NL), Fondation Fond'action (ILG) and Fondation NOVA (ILG).