01. Understanding NIPEC
What Is NIPEC?
Normothermic intraperitoneal chemotherapy (NIPEC) is a liquid chemotherapy wash applied directly within the abdominal cavity. The chemotherapy is kept at body temperature and typically administered in multiple rounds.
NIPEC is a treatment option for malignant peritoneal mesothelioma, as well as other abdominal cancers.
How Is NIPEC Different From Systemic Chemotherapy?
Many people are familiar with systemic chemotherapy. Chemotherapy washes, such as NIPEC, differ based on how they are administered to a patient.
- Systemic chemotherapy treatment is traditionally administered intravenously (through an IV). This type of chemotherapy travels throughout the patient’s bloodstream and can reach any part of the body. Some forms of systemic chemotherapy may be available in pill or liquid form, too.
- Chemotherapy washes consist of a liquid medication circulated in a targeted area of the body. The wash is confined to the part of the body where the cancer is located.
Systemic chemotherapies are often used to treat mesothelioma. However, advancements in targeted chemotherapy washes like NIPEC have improved patient outcomes. NIPEC targets the peritoneal cavity (abdominal cavity).
How Is NIPEC Different From Other Chemotherapy Washes?
NIPEC may differ from other chemotherapy washes based on medication temperature and when the treatment is given.
NIPEC is body-temperature chemotherapy typically used as a long-term course of treatment. Doctors administer the first round of NIPEC 4 – 6 weeks after surgery.
The three main types of chemotherapy washes used to treat peritoneal mesothelioma are HIPEC, EPIC and NIPEC.
- Hyperthermic intraperitoneal chemotherapy (HIPEC) is a heated chemotherapy wash administered during surgery.
- Early postoperative intraperitoneal chemotherapy (EPIC) is administered immediately after surgery.
- Normothermic intraperitoneal chemotherapy (NIPEC) is a body-temperature chemotherapy wash administered 4 – 6 weeks after surgery.
02. The NIPEC Procedure
What Is the NIPEC Treatment Procedure?
NIPEC is a multi-step process with multiple cycles of the chemotherapy wash. NIPEC is typically administered after cytoreductive surgery (CRS) to kill remaining cancer cells.
The intraperitoneal port to administer NIPEC is usually inserted at the end of the patient’s surgical procedure. A port is a small, temporarily implanted, device that allows doctors to deliver chemotherapy drugs without sticking patients with a needle during each chemotherapy round.
NIPEC may be administered as an inpatient or outpatient procedure. For outpatient procedures, patients often aren’t required to be hospitalized throughout NIPEC treatment. In both cases, patients will spend time in the hospital after CRS for recovery.
Typical NIPEC Procedure Steps
- Port insertion: Physicians insert a port into the patient’s abdomen at the end of surgery. This is referred to as an intraperitoneal port.
- Chemotherapy administration: Around 4 – 6 weeks after surgery, the physician will begin administering chemotherapy through the port. The chemotherapy solution is kept at body temperature. The first cycle of NIPEC may be completed in one day or across consecutive days. Patients will discuss a treatment schedule with their specialist.
- Additional cycles of NIPEC: Peritoneal mesothelioma patients commonly undergo multiple cycles of NIPEC. Researchers report there are typically six cycles across six months. As a long-term course of treatment, NIPEC is often referred to as NIPEC long-term or NIPEC-LT.
- Port removal: Once patients complete all of their NIPEC cycles, a physician will remove the port from their abdomen. Doctors typically advise patients to monitor the port site for signs of infection.
03. Advantages & Disadvantages
Advantages and Disadvantages of NIPEC
NIPEC and other targeted chemotherapies have some advantages over traditional systemic chemotherapies. They also have a few disadvantages.
In comparison to systemic chemotherapy, NIPEC:
- May result in fewer or less severe side effects
- Reaches more cancerous cells when circulated throughout the abdominal cavity
- Allows physicians to use higher concentrations of medication
In comparison to systemic chemotherapy, NIPEC:
- Requires the patient to have a port inserted into their abdomen
- Is not widely available to peritoneal mesothelioma patients
Patients should discuss all potential advantages and disadvantages with their oncologists.
04. NIPEC Treatment Combinations
Is NIPEC Combined With Other Treatments?
Studies show NIPEC being used alongside other cancer treatments. NIPEC is often an adjuvant therapy, meaning it is administered after other therapies. Treatment plans consisting of multiple therapies are referred to as multimodal treatments.
Research on different NIPEC treatment combinations is limited. However, existing studies have shown NIPEC used with CRS, HIPEC and EPIC. If eligible for multimodal treatments, patients may be able to improve their mesothelioma prognosis.
05. NIPEC Success Rates
How Successful Is NIPEC for Treating Mesothelioma?
NIPEC has been able to improve survival rates for peritoneal mesothelioma patients. NIPEC has also been successful in treating ovarian cancer and gastric cancer.
According to studies, NIPEC seems to work best as part of a multimodal treatment plan. It has been most successful when combined with CRS and HIPEC. These three treatments together have led to median survival ranging from about 6 to 15 years.
In one study, Dr. Paul Sugarbaker reported success in improving 5-year peritoneal mesothelioma survival rates. The study compared 5-year survival rates of patients who received different treatment combinations. The combination with NIPEC demonstrated the highest 5-year survival rate. Dr. Sugarbaker also tested surgery combinations with other chemotherapy washes.
A 2020 study also demonstrated success with NIPEC for peritoneal mesothelioma. This study was conducted at the MedStar Washington Hospital Center. Researchers worked with a small group of six peritoneal mesothelioma patients. All patients underwent at least three rounds of NIPEC.
Researchers reported patient survival of 8 – 19 years after NIPEC treatment. This research reveals how promising NIPEC may be for peritoneal mesothelioma. However, studies so far represent a small number of patients. Additional studies are necessary to learn more about this treatment.
For example, this particular study used the chemotherapy drug paclitaxel. Additional studies may help researchers determine which chemotherapy drugs work best for NIPEC treatment.
Resources for Mesothelioma Patients
06. NIPEC Side Effects
What Are the Potential Side Effects of NIPEC?
As with other cancer treatments, NIPEC has a range of potential side effects, including:
- Bone marrow suppression (low red blood cells and immune function)
- Decreased appetite
- Increased breathing rate
- Kidney failure
- Nausea and vomiting
- Port-site infection
- Pressure or bloating in the abdomen
- The sensation of needing to urinate
HIPEC, NIPEC and EPIC often result in fewer side effects than standard chemotherapy. Systemic chemotherapy travels throughout the patient’s bloodstream. The drug then interacts with cells throughout the body.
Potential side effects vary from patient to patient. Patients should discuss the risk of complications with their physician. Older patients or those in poor overall health may be more susceptible to the negative effects of NIPEC.
07. Where to Find NIPEC
Where to Find NIPEC Treatment for Mesothelioma
NIPEC is not widely available in the United States for peritoneal mesothelioma patients. NIPEC is still new compared to other standard cancer treatments. Patients should consult with their specialist to determine if NIPEC is an option and where it may be available.
Mesothelioma cancer centers continue to expand their treatment options for mesothelioma patients as research evolves. For example, a number of treatment centers now offer HIPEC.
Before pursuing NIPEC, patients should talk to their doctor about the possibility of a chemotherapy wash as part of their treatment plan. Mesothelioma specialists can provide the best insight into a patient’s individual options. Even if a patient is ineligible for NIPEC, other treatment options may improve quality of life and survival.
08. Common Questions
Common Questions About NIPEC for Mesothelioma
Does NIPEC cause hair loss?
- NIPEC is less likely to cause hair loss than systemic chemotherapy because it is confined to the abdominal cavity. Systemic chemotherapy is more likely to cause hair loss because it targets fast-growing cells, which includes hair cells.
What is the difference between HIPEC and NIPEC?
- Both NIPEC and HIPEC bathe the abdominal lining in chemotherapy. NIPEC uses body-temperature chemo and happens sometime after surgery. HIPEC uses heated chemo and happens during surgery. The heat helps kill cancer cells but is cool enough to leave healthy cells mostly unharmed.
How much does NIPEC cost?
- In a study, a procedure similar to NIPEC had a direct variable cost of about $21,000. But the cost of mesothelioma treatment can vary greatly between patients. Treatment type, number of cycles, insurance plans and other factors can influence what individuals will pay. A doctor or patient advocate can help patients understand what the cost of NIPEC will be. Individuals can help pay for treatment in several ways, including participating in clinical trials and pursuing mesothelioma compensation.
What are some examples of intraperitoneal chemotherapy?
- Types of intraperitoneal chemotherapy, or chemo applied within the abdominal lining, include:
- HIPEC: A heated chemotherapy wash administered during surgery
- EPIC: A chemotherapy wash administered immediately after surgery
- NIPEC: A body-temperature chemotherapy wash administered 4 – 6 weeks after surgery