Managing Resected CRC Peritoneal Metastasis Following Recurrence


Treatment options in the refractory setting must improve for patients with resected colorectal cancer peritoneal metastasis, says Muhammad Talha Waheed, MD.

Earlier recurrence following surgery for colorectal cancer (CRC) peritoneal metastases confers a higher risk of morbidity and mortality for patients, according to Muhammad Talha Waheed, MD.

In a conversation with CancerNetwork® during the 2024 Society of Surgical Oncology Annual Meeting (SSO), Waheed, a research fellow in the Department of Surgical Oncology at City of Hope National Medical Center in Duarte, California, spoke about the implications of findings from his presentation on a Peritoneal Surface Oncology Alliance for Research and Innovative Solutions (PSOLARIS) group study. Results highlighted that recurrence-free survival (RFS) and peritoneal-RFS could be used as surrogate end points for overall survival in CRC peritoneal metastasis efficacy trials.1

Waheed also discussed how treatment strategies must improve for patients with resected CRC peritoneal metastases who have disease recurrence. He highlighted that findings from a phase 1 trial (NCT04329494) assessing pressurized intraperitoneal aerosolized chemotherapy (PIPAC) appear to be promising for those with refractory disease.2


Shorter recurrence-free survival, or early recurrence after surgery, is generally associated with a worse prognosis. It could be due to several reasons, including any missed disease on the preoperative scans, disease after surgery that was left behind, or just simply because of aggressive disease biology. Also, early recurrence is associated with complications and symptoms for the patients, as well as higher morbidity and mortality. That changes the overall survival or the quality of life for that patient.

[Treatment decisions] would depend on the type of relapse that a patient has. Is it a distal recurrence? Is it a local recurrence? Is it a distal plus local recurrence? Different treatment options do exist. For patients [with refractory disease], with however many refractory peritoneal metastases, we do 2 lines of chemotherapy, then we have an option for third-line systemic chemotherapy, including, for example, trifluridine/tipiracil [Lonsurf] or regorafenib [Stivarga]. In the refractory setting, these [treatments] are associated with an overall survival of 6 months. We do need to find better and improved treatment options for these patients who are not doing well.

Fortunately, there is an exciting and emerging experimental approach that is being evaluated for patients with refractory disease, and it’s called PIPAC, or pressurized intraperitoneal aerosolized chemotherapy. The first-ever phase 1 United States PIPAC trial was recently published in collaboration with City of Hope, Northwell Health, and Mayo Clinic, and it has some encouraging results.2 It’s very early and it’s a phase 1 trial as of yet, but I think it’ll be really interesting to see how that pans out.


  1. Waheed MT, Kepenekian V, Sourrouille I, et al. Reliability of recurrence-free survival as an efficacy endpoint for trials of resected colorectal cancer peritoneal metastasis: results from the PSOLARIS study group. Presented at the Society of Surgical Oncology (SSO) 2024 Annual Meeting; March 20 – 23, 2024; Atlanta, GA; abstract 68.
  2. Raoof M, Whelan RL, Sullivan KM, et al. Safety and efficacy of oxaliplatin pressurized intraperitoneal aerosolized chemotherapy (PIPAC) in colorectal and appendiceal cancer with peritoneal metastases: results of a multicenter phase I trial in the USA. Ann Surg Oncol. 2023;30(12):7814-7824. doi:10.1245/s10434-023-13941-2.
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