Optimizing intraperitoneal drug delivery

Abstract Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a drug delivery system and a technical solution addressing systematically known limitations of intraperitoneal (IP) chemotherapy. Coherent and promising preclinical experimental as well as results from Phase-I, Phase-II studies and patient cohorts in several indications with various drugs suggest that PIPAC might be a significant step forward to improve efficacy of IP chemotherapy – and reducing its toxicity. PIPAC is not a defined therapy but a generic system for IP drug delivery able to aerosolize a large range of substances in a variety of diseases and indications. Data available strongly suggests that increased efficacy of PIPAC is due to the highly effective mode of distribution of a drug into tumour nodes rather than to a particular drug. A rationale for this enhanced target effect is that PIPAC overcomes elevated intratumoral interstitial fluid pressure by applying an artificial hydrostatic pressure to the abdominal cavity.