Written by Karen Selby, RN | Edited By Walter Pacheco | Last Update: August 29, 2024

What Is NIPEC?

Normothermic intraperitoneal chemotherapy, or NIPEC, is a room-temperature chemotherapy wash. Doctors administer it through an abdominal port. NIPEC, or NIPEC-LT, is a long-term treatment for malignant peritoneal mesothelioma patients.

It complements surgery by delivering consistent anti-cancer medication over multiple cycles. That complements surgery by delivering consistent anti-cancer medication over numerous cycles. 

Delivering chemotherapy throughout the abdomen is called HIPEC, which is also known as hyperthermic intraperitoneal chemotherapy. HIPEC chemotherapy is administered warm and only once during cytoreductive surgery. NIPEC advances this method. It extends the anti-cancer effects of surgery and potentially improves disease-free survival.  

Peritoneal specific questions I encounter commonly are what is the NIPEC procedure and how does a doctor determine whether that is done or not? Do they need further chemo after NIPEC?

Dr. Snehal Smart, medical doctor and Patient Advocate
Snehal Smart, M.D. and Patient Advocate at The Mesothelioma Center

Is NIPEC Different Than Conventional Chemotherapy?

For many years, chemotherapy has been systemic. It involves administering intravenous anti-cancer drugs through an IV line inserted in a vein or port. Systemic chemotherapy travels throughout the body in the bloodstream and eventually reaches cancerous cells through small blood vessels. 

NIPEC is an innovative type of chemotherapy wash applied directly to cancerous tissue within the abdomen. Called a “chemo bath,” the chemotherapy medication fills and circulates in the abdominal cavity, killing cancer cells and reducing the chance of recurrence.

Is NIPEC Better Than Other Chemotherapy Washes?

Evidence suggests NIPEC is most effective when combined with other chemotherapy washes. 

HIPEC, EPIC and NIPEC are the three primary chemotherapy washes used to treat peritoneal mesothelioma. They vary based on temperature and length of treatment.

  • HIPEC is hyperthermic, or heated, intraperitoneal chemotherapy applied only once, during cytoreductive surgery.
  • EPIC is early postoperative intraperitoneal chemotherapy. It is a slightly delayed form of HIPEC given shortly after surgery.
  • NIPEC is normothermic, or room-temperature, intraperitoneal chemotherapy. It is administered regularly for several weeks after surgery.

Patients have longer survival times when undergoing surgery with HIPEC, followed by EPIC and a series of NIPEC treatments. A 2022 study found that these interventions improved 5-year survival to about 80%.

The recommended administration of NIPEC is to give the first dose at four to six weeks postoperatively, followed by five more cycles with three weeks between each treatment. 

This new treatment may offer advantages over other chemotherapy washes alone because it is a long-term therapy that eradicates cancer cells long after surgery.

How Is NIPEC Used to Treat Peritoneal Mesothelioma?

Doctors are still developing the best techniques for administering NIPEC. It has shown promising results in gastric cancer, ovarian cancer and peritoneal mesothelioma.  

Ovarian cancer and peritoneal mesothelioma are two cancers caused by asbestos-contaminated talc.  

Dr. Paul H. Sugarbaker is a pioneer in peritoneal therapy. He has worked on NIPEC as a new standard that improves patient survival over HIPEC mesothelioma treatment and other washes.  

The NIPEC procedure can be either an inpatient or outpatient procedure. Doctors deliver it once patients have recovered from surgery.  

NIPEC Steps

NIPEC administration involves several steps and multiple chemotherapy cycles. In most cases, surgeons install the port during the initial surgery.

  1. Port Insertion: The surgeon will insert a device called an intraperitoneal port into the patient’s abdomen at the end of surgery. The port is a small device that allows doctors to administer medication or withdraw excess fluid.
  2. Chemotherapy Administration: Patients receive the first dose of NIPEC four to six weeks after their surgery. The doctor then administers NIPEC every three weeks for up to six cycles. Hospital time and visit length will depend on the patient’s treatment schedule.
  3. Port Removal: Patients are responsible for monitoring their port for signs of infection or leaking. At the end of their therapy, the doctor will remove the intraperitoneal port and apply a dressing over the wound.

After port removal, home care may involve regularly cleaning the wound, checking for infection and monitoring for any worsening signs or symptoms. Patients who undergo NIPEC should inform their doctor immediately if they notice worsening or persisting inflammation, discharge or fever.

Combining NIPEC with Other Forms of Mesothelioma Treatment

Doctors administer NIPEC after surgery as an adjuvant treatment in a multimodal plan. Multimodal treatment offers many anti-cancer therapy methods working together to eradicate tumors. 

Combining treatment improves survival times and the prognosis for mesothelioma. 

NIPEC is still in its early stages. It is most effective after cytoreductive surgery when combined with other chemotherapy washes, such as HIPEC and EPIC.

What Is the Success Rate of NIPEC?

We measure mesothelioma treatment success by the percentage of patients who live beyond five years, which doctors call the five-year survival rate. 

5-Year Survival Rate of Chemotherapy Washes for Peritoneal Mesothelioma Patients
NIPEC following HIPEC and post-surgical EPIC 75%
HIPEC followed by EPIC after surgery 52%
HIPEC alone administered during surgery 44%

NIPEC can improve peritoneal mesothelioma patients’ five-year survival rate. It increases surgical effectiveness alongside other chemotherapy washes, such as HIPEC.

Dr. Paul Sugarbaker’s Innovative Approach to NIPEC Treatment

Over twenty years ago, Sugarbaker helped create the current peritoneal mesothelioma treatment standard of HIPEC. Since then, he’s identified the technique’s shortcomings and developed NIPEC as the solution. 

Surgeons first used NIPEC for ovarian cancer, but Sugarbaker explored its potential for peritoneal mesothelioma cancer in 2012. 

In our study, the five-year survival rate went from 50% for those in the control group to more than 75% for those receiving the NIPEC. If others can duplicate the success that we’ve had, everyone will benefit. It will change the way people look at this disease, and the way it is treated.

Dr Sugarbaker
Dr. Paul H. Sugarbaker, surgical oncologist and peritoneal specialist

Although the current results are impressive, Sugarbaker remains one of the few surgeons using it consistently today. He published a retrospective in 2020 of six malignant peritoneal mesothelioma patients treated with NIPEC. Four patients were free of disease after 8, 13, 18 and 19 years, and two patients died of illness 15 years after definitive treatment.

Treatment Centers Offering the NIPEC Procedure

Due to its limited development, NIPEC is unavailable as a standard treatment at most mesothelioma treatment centers. 

Sugarbaker currently serves as chief of the Peritoneal Surface Malignancy Program at the MedStar Washington Hospital Center in Washington, D.C., where patients may undergo NIPEC if they are eligible. 

At MedStar Washington Hospital Center, Sugarbaker conducted his study on six peritoneal mesothelioma patients who lived eight to 19 years after receiving NIPEC. 

As development on NIPEC continues, treatment centers are expanding the availability of HIPEC and other intraperitoneal treatments. Patients should consult with their mesothelioma specialist about the possibility of a chemotherapy wash as part of their treatment plan.

NIPEC Treatment Side Effects

NIPEC is a long-term chemotherapy regimen with potential side effects. Side effects of chemotherapy wash such as NIPEC and HIPEC are usually fewer or milder than with systemic chemotherapy. 

Common Side Effects of NIPEC Treatment
  • Nausea
  • Vomiting
  • Pain
  • Insomnia
  • Weight loss
  • Abdominal pain
  • Diarrhea
  • Constipation
  • Depression

As with any procedure, NIPEC can cause complications. Complication risks will vary based on the patient’s overall health and stage of the disease.

Possible NIPEC Complications
  • Hemorrhages (bleeding)
  • Sepsis (systemic infection)
  • Pleural effusion
  • Wound infection
  • Kidney failure
  • Bone marrow suppression

While NIPEC offers many benefits to long-term survivability, it can also have some disadvantages. Patients should discuss the pros and cons with their doctor, as other treatment options may provide better benefits.

Pros and Cons of NIPEC Compared to Conventional Chemotherapy
Pros
  • Fewer and less severe side effects
  • Provides better survival rates
  • Long-term effects suppress cancer recurrence
Cons
  • Possible complications could cause more damage
  • Not yet available at most treatment centers
  • Only surgical candidates are eligible for NIPEC

NIPEC is an exciting new treatment that may represent the future of peritoneal mesothelioma therapy. Combining long-term NIPEC with other chemotherapy washes has improved survival rates, but more research is still needed. 

Researchers and specialists will continue to evaluate NIPEC for safety and effectiveness until the procedure becomes widely available.

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