ASO Author Reflections: Futility of Mitomycin C HIPEC in Colorectal Peritoneal Metastases-Time for a Change

PastColorectal cancer peritoneal metastases (CRC-PM) represent the second most common site of metastatic spread after the liver.They constitute an aggressive and distinct clinical entity associated with poor prognosis and impaired quality of life.Cytoreductive surgery (CRS), with or without hyperthermic intraperitoneal chemotherapy (HIPEC), has long been practiced as standard treatment for appropriately selected patients with resectable disease. 1 However, the use of HIPEC for CRC-PM has increasingly been questioned.PRODIGE 7, an open-label, multicenter, phase III randomized trial, failed to demonstrate a survival benefit with oxaliplatin-based HIPEC added to CRS compared with CRS alone in patients with resectable CRC-PM.The trial nevertheless generated considerable debate regarding patient selection, the choice and duration of the HIPEC regimen, and the clinical endpoints evaluated.Importantly, the median overall survival of approximately 41 months in both groups established a new benchmark for outcomes after complete or near complete cytoreduction in selected patients.2 Following PRODIGE 7, many cancer centers transitioned toward mitomycin C (MMC)-based HIPEC, although no level I evidence has established its superiority over the oxaliplatin regimen used in PRODIGE 7. 3 In response to the trial findings, our center systematically discontinued HIPEC for CRC-PM.We have now reported our institutional experience following this change in practice, comparing outcomes after CRS alone with those of patients previously treated with CRS and HIPEC using propensity score matching.