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Korean Cancer Doctors Embrace PIPAC for Mesothelioma

PIPAC for mesotheliomaFive out of ten Korean oncologists surveyed feel positive about using an aerosolized chemotherapy system called PIPAC for mesothelioma and other types of cancer.

PIPAC stands for pressurized intraperitoneal aerosol chemotherapy. The system turns liquid chemotherapy drugs into a spray that can be applied with a nebulizer. It was developed to treat surface malignancies like peritoneal mesothelioma that can be hard to treat with standard methods. 

PIPAC can be used in conjunction with mesothelioma surgery or by itself as either a palliative or curative treatment. 

The technology is still very new. Many doctors have never used it. But research conducted by the Seoul National University College of Medicine shows Korean doctors are ready to embrace it.

How Spray-on Chemotherapy Works

Mesothelioma cells are notoriously difficult to kill. The idea behind both HIPEC and PIPAC for mesothelioma is to deliver cancer-killing drugs directly to the tumor site. This precise delivery helps to minimize side effects. 

HIPEC stands for heated intraperitoneal chemotherapy. With HIPEC, doctors rinse heated drugs through a patient’s abdomen immediately after cytoreductive surgery (CRS). For patients who are good candidates, the CRS/HIPEC technique appears to offer the best odds of mesothelioma survival. 

PIPAC is similar but may offer more flexibility. With PIPAC, surgeons insert a spraying device called a nebulizer into the abdomen through an incision. Using an internal camera for guidance, they spray a cocktail of chemotherapy drugs onto the membrane where peritoneal mesothelioma tumors grow. 

If a peritoneal tumor is too large or widespread for CRS/HIPEC, PIPAC may function as a sort of bridge to surgery. One French study found that PIPAC for mesothelioma may increase the chances of being able to remove a tumor completely. 

PIPAC can also be used curatively. In a 2018 European study of mesothelioma patients who had more than two PIPAC treatments, 75 percent experienced some tumor regression. Ten percent of those patients had complete regression. Median overall survival was 26.6 months. 

High Acceptance and High Hopes for PIPAC for Mesothelioma 

Not all doctors are quick to embrace new technology. But the new study in Anticancer Research suggests that many Korean doctors are ready for PIPAC for mesothelioma and other cancers. 

Researchers sent a 20-question survey to 164 cancer doctors. Some of these doctors were mesothelioma specialists. Others focused on other kinds of cancer. 

Among the doctors who treat mesothelioma, ovarian cancer, or pseudomyxoma peritonei, 41.7 – 50 percent preferred PIPAC as a curative treatment. Among colorectal and hepatobiliary specialists, 32.7 – 33.3 percent chose PIPAC for palliative treatment of recurrent cancer. 

“Furthermore, 66.7-95.2% considered PIPAC appropriate for the cancers they specialized in, and 76-78.7% expected a treatment response of more than 50%,” reports study author Eun Ji Lee. These doctors indicated that they were OK with some low-grade complications from the treatment.

PIPAC for mesothelioma was developed in Germany and is being pioneered in Europe. It is not yet widely available in the US. Surgeons at the Mayo Clinic in Jacksonville, Florida performed the first US PIPAC procedure in December, 2019.


Eun, JL, et al, “The Clinical Desire for Pressurized Intraperitoneal Aerosol Chemotherapy in South Korea: An Electronic Survey-based Study”, January 2022, Anticancer Research, https://ar.iiarjournals.org/content/42/1/363

Nazario, Brunila, “Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC)”, June 18, 2020, WebMD, https://www.webmd.com/cancer/what-is-pipac

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