HIPEC/CRS Confers No Benefit, Adds Risk in Colorectal Peritoneal Metastases

In an interview with CancerNetwork®, Muhammad Talha Waheed, MD, stated that it’s important to consider the risk vs benefit ratio when administering treatments to patients. At the 2025 Society of Surgical Oncology Annual Meeting (SSO), he presented a poster that showed “no added benefit” of hyperthermic intraperitoneal chemotherapy (HIPEC) added to cytoreduction surgery (CRS) in patients with colorectal cancer who have peritoneal metastasis.¹

Waheed, a postdoctoral research fellow at City of Hope Comprehensive Cancer Center in Duarte, California, also spoke about the phase 3 PRODIGE-7 trial (NCT00769405), which evaluated the benefits and risks of adding HIPEC to CRS. That trial showed that at 30 days, grade 3 or higher adverse events (AEs) occurred in 42% of the CRS plus HIPEC group vs 32% in the CRS alone group (P = .083); at 60 days, grade 3 or higher AEs occurred in 26% vs 15% (P = .035).²

In Waheed’s study, results showed that HIPEC did not confer any added survival benefit: 1-year overall survival (OS) was 100% with CRS alone and 84.3% with CRS plus HIPEC (P = .006). Additionally, recurrence-free survival was similar in both groups.

Transcript:

When choosing a treatment option, there always has to be a discussion of risk vs benefit. When looking at the benefits specifically, our results report no added benefit of HIPEC. That begs the question, what is the benefit that you’re giving to these patients? At this point, we’re not able to comment on the risks because we were not able to compare the complications, but we’re in the process of abstracting those data. We will be able to compare the risks associated with either of the treatments, and we will report them in the paper.

Very interestingly, PRODIGE-7 did look at the complication rates between the 2 arms, which was the CRS alone treatment arm, and compared that with patients who underwent [CRS] with HIPEC [plus] oxaliplatin. They reported, although non-significant, that 30-day severe complications were higher in patients undergoing HIPEC. [Complications] 31 to 60 days after surgery were significantly higher in patients undergoing HIPEC. That begs the question: when you’re not able to provide any benefit, and there’s a risk or chance of increased complications for these patients, is there utility to still offer HIPEC?

The current data do support the use of HIPEC in [patients with] appendix cancer with peritoneal metastasis, so we continue to offer that for those patients. HIPEC, with some other agents, continues to be offered for [patients with] ovarian cancer at our center and nationwide. That is where I think this application—[CRS with HIPEC]—still is relevant.

References

1. Waheed MT, Paz IB, Lwin T, et al. Impact of systematic discontinuation of mitomycin C (MMC) HIPEC for colorectal peritoneal metastasis (CRCPM) on oncologic outcomes at an NCI cancer center. Presented at SSO 2025; March 27-29, 2025; Tampa, FL.
2. Quénet F, Elias D, Roca L, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22(2):256-266. doi:10.1016/S1470-2045(20)30599-4