01. What Is NIPEC?
What Is NIPEC?
Normothermic intraperitoneal chemotherapy (NIPEC) is a liquid chemotherapy wash applied directly within the abdominal cavity. The chemotherapy is kept at room 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.
- Chemotherapy washes consist of a liquid medication circulated in a targeted area of the body. The wash is confined to a cavity where the cancer is located.
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 room-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 after surgery.
- Early postoperative intraperitoneal chemotherapy (EPIC) is administered immediately after surgery.
- Normothermic intraperitoneal chemotherapy (NIPEC) is a room-temperature chemotherapy wash administered 4 – 6 weeks after surgery.
02. The NIPEC Procedure
What Does the NIPEC Procedure Entail?
NIPEC is a multi-step process with multiple cycles of the chemotherapy wash. NIPEC is typically administered after cytoreductive surgery to kill remaining cancer cells. As a result, the port to administer NIPEC is usually inserted at the end of the patient’s surgical procedure.
Cytoreductive surgery is also referred to as cytoreduction, debulking or CRS. It is a type of surgery that removes as much malignant tissue as possible.
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.
1. Port Insertion
Physicians insert a port into the patient’s abdomen after surgery. This is referred to as an intraperitoneal port.
2. Chemotherapy Is Administered Through the Port
Around 4 – 6 weeks after surgery, the physician will begin administering chemotherapy through the port. The chemotherapy solution is kept at room 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.
3. Multiple Cycles of NIPEC Are Administered
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.
4. Port Is Removed
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
As with all cancer treatments, there are pros and cons of undergoing NIPEC.
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
- 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. In other words, 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 cytoreductive surgery, 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 5-year survival rates for peritoneal mesothelioma patients. NIPEC has also been successful in treating ovarian cancer and gastric cancer.
In one study, Dr. Paul Sugarbaker reported success in extending survival in peritoneal mesothelioma patients when combining NIPEC with other cancer treatments.
The treatment combination with NIPEC demonstrated the highest 5-year survival rate. Dr. Sugarbaker also tested surgery combinations with other chemotherapy washes.
Study Results: 5-Year Survival Rates for Peritoneal Mesothelioma Patients
- CRS + HIPEC: 44%
- CRS + HIPEC + EPIC: 52%
- CRS + HIPEC + EPIC + NIPEC: 75%
–Based on a study of 129 peritoneal mesothelioma patients (29 patients underwent CRS+HIPEC+EPIC+NIPEC).
Another study, published in 2020, 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. Some of these patients are still alive with no evidence of disease.*
*NIPEC research is limited and this data represents a small sample size of patients. Survival may vary widely in a study with more participants.
This particular study used 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:
- Loss of appetite
- Abdominal pressure or bloating
- Sensation of needing to urinate
- Increased breathing rate
- Port-site infection
- Kidney failure
- Bone marrow suppression
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.
Does NIPEC Cause Hair Loss?
Because NIPEC is confined to the abdominal cavity, it is less likely to cause hair loss than systemic chemotherapy.
Systemic chemotherapy targets fast-growing cells, which includes hair cells. This causes hair loss.
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, there are other treatment options that may improve quality of life and survival.