NIPEC Treatment for Peritoneal Mesothelioma

What Is NIPEC?

NIPEC stands for normothermic intraperitoneal chemotherapy and is used as a peritoneal mesothelioma treatment. It’s a chemo wash at room temperature that doctors put directly into the belly of people with peritoneal mesothelioma. “Normothermic” means the chemo is the same temperature as the body. NIPEC helps kill any leftover cancer cells without using the extra heat that HIPEC does. 

The first dose of NIPEC is typically given 4 to 6 weeks after surgery. In rare cases or during clinical trials, NIPEC may be given before surgery. Using NIPEC before surgery is considered experimental and isn’t common. 

Key Facts About NIPEC for Mesothelioma

1. May lower risk of cancer returning: NIPEC destroys leftover cancer cells after surgery, which may reduce the chance of the cancer coming back. Ongoing chemo cycles can help prevent leftover cancer cells from growing after surgery.
2. Uses specific chemo drugs: Some of the most common chemo drugs used for NIPEC treatment are cisplatin, mitomycin C and doxorubicin.
3. Targets the abdomen with fewer side effects: Since NIPEC delivers chemo directly to the belly, it may cause fewer whole-body side effects than traditional chemo.

NIPEC builds on the idea of HIPEC, which stands for hyperthermic intraperitoneal chemotherapy. HIPEC uses heated chemo during surgery and doctors give it just once. NIPEC uses chemo at normal body temperature and gives it directly into the belly over several treatments.

Some similar chemo washes include EPIC, which stands for early postoperative intraperitoneal chemotherapy. It uses chemo drugs given directly into the abdominal cavity for several hours. It’s a slightly delayed form of HIPEC. HITOC, or hyperthermic intrathoracic chemo, is also a localized chemo treatment. It’s similar to NIPEC, but it’s used in the chest cavity for people with pleural mesothelioma.

How Is NIPEC Used to Treat Peritoneal Mesothelioma?

NIPEC sends chemo directly into the belly where the cancer grows to treat peritoneal mesothelioma. The chemo can reach spots where cancer cells hide between organs or in tissue folds. This direct contact given over multiple cycles allows the chemo to attack the cancer more effectively than when given through a vein. 

Regular chemo doesn’t always work well for peritoneal mesothelioma because the cancer spreads across the thin lining of the belly. NIPEC lets the medicine cover a wide area inside the abdomen. This treatment targets the areas where the cancer grows the most and helps doctors fight it more directly.

How NIPEC for Mesothelioma Is Administered

You can receive NIPEC as either an inpatient or outpatient treatment. During NIPEC treatment, doctors place a small port in the belly after surgery. They use this port to send room-temperature chemo for mesothelioma straight into the belly. 

The chemo spreads through the area to reach cancer cells. Doctors repeat this process every few weeks. NIPEC slows the cancer down and gives you longer breaks between treatments.

Steps to Receiving NIPEC Treatment 

1. Port insertion: Your surgeon will insert a device called an intraperitoneal port into your abdomen at the end of tumor-removing surgery. The port is a small device that allows doctors to administer medication or withdraw excess fluid.
2. Chemo delivery: Several weeks after surgery, your doctor will give you chemo every 3 weeks, up to 6 times. How long each visit takes depends on your treatment plan. 
3. Port removal: You should watch your port for signs of infection or leaks. When treatment ends, your doctor removes the port and covers the area with a bandage.

After your doctor removes the port, you may need to clean the wound regularly and check for signs of infection. Call your doctor right away if you see swelling, discharge or a fever that doesn’t go away. 

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What Are the Benefits of NIPEC for Mesothelioma?

NIPEC has several benefits for people with mesothelioma. It sends chemo straight into the belly, which helps it reach hidden cancer cells and cover a larger area than regular chemo.

Success of NIPEC for Mesothelioma

• Helps more people get surgery: A 2025 study found NIPEC helped people with stomach cancer become healthy enough for surgery. This surgery added about 8 extra months to their lives.
• Makes surgery work better: Research shows that NIPEC, when used following other chemo washes, helps surgery remove more cancer and improves the overall results.
• May help people live longer: A study in the European Journal of Surgical Oncology found people with cancer that wasn’t removed after surgery lived much longer when they got NIPEC, about 24.5 months compared to 10.3 months for those who didn’t.

Chemo washes like NIPEC or HIPEC usually cause fewer or milder side effects than regular chemo. That’s because doctors put the medicine straight into the belly, where the cancer is. The chemo stays in that area and doesn’t have to travel through the whole body. When used after HIPEC, NIPEC may help patients live more than 30% longer.

What Are the Side Effects of NIPEC for Mesothelioma?

Despite fewer issues compared to whole-body chemo, since the medicine doesn’t need to travel through the entire bloodstream, the drugs used in NIPEC still have potential side effects. This mesothelioma cancer treatment can also lead to other problems, just like any other medical procedure. 

Common Side Effects of NIPEC Treatment

• Abdominal pain
• Constipation
• Depression
• Diarrhea
• Insomnia
• Nausea
• Pain
• Vomiting
• Weight loss

Most treatment centers don’t offer NIPEC. The treatment is available at Moffitt Cancer Center in Tampa, MedStar Washington Hospital Center in D.C., Memorial Sloan Kettering in New York City and Roswell Park in Buffalo. Our Patient Advocates can help you connect with these mesothelioma treatment centers and join a possible clinical trial.

Doctors are still learning how safe and effective NIPEC is before more hospitals begin using it. Dr. Paul H. Sugarbaker helped lead the way in peritoneal cancer treatment. He believes NIPEC could help patients live longer compared to HIPEC and other chemo washes.

Rare But Serious NIPEC Side Effects

NIPEC can cause side effects, just like any medication. Your risk of complications depends on your overall health and how far the cancer has spread.

Serious NIPEC Complications

• Bone marrow suppression
• Kidney failure
• Sepsis (systemic infection)

Because NIPEC happens after surgery, people may also experience surgical complications. These can include bleeding (hemorrhages), fluid buildup (pleural effusions) and wound infections. 

Serious side effects and surgical complications are rare, but it’s important to watch for any signs. If you notice anything unusual, tell your doctor right away.

Managing NIPEC Side Effects

You can do many things to manage side effects from NIPEC. These tips can help you feel better, stay stronger and heal faster.

Tips for Easing Side Effects

• Medications: Talk to your doctor about anti-nausea medications.
• Nutrition: Eat small, healthy meals and avoid greasy, fried or spicy foods. This will help keep your digestion on track and reduce the risk of stomach problems during treatment.
• Report any pain: Tell your doctor if you’re experiencing any pain and ask if it’s safe to take over-the-counter pain medications.
• Rest: Get plenty of sleep and practice deep breathing to calm your mind.
• Stay hydrated: Drink plenty of fluids.
• Watch for signs of infection: Report any signs of infection as soon as possible.

Talk to your mesothelioma doctor before you take any over-the-counter or herbal medicine. Some of these can change how your treatment works or make side effects worse.

Who’s Eligible for NIPEC Treatment?

NIPEC is for people with peritoneal mesothelioma who’ve had surgery to remove as much of the cancer as possible. Doctors look at how far the cancer has spread, how healthy the person is and if the surgeon can safely remove all visible cancer when deciding if someone can get NIPEC.

Eligibility Criteria for NIPEC

• Cytoreduction surgery: You must have had surgery to remove as much cancer as possible to qualify for NIPEC.
• No distant metastasis: Cancer shouldn’t have spread beyond the abdominal cavity.
• Overall health: You should have good overall health and be free of pre-existing issues.
• Peritoneal mesothelioma diagnosis: You must have peritoneal mesothelioma.
• Physical strength: You should be able to handle the physical demands of surgery and chemo.

Medical doctor and Patient Advocate Dr. Snehal Smart tells us, “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?”

Meeting the eligibility requirements is important for staying safe and getting the best results from the treatment. Your doctor can help you understand the risks and benefits and decide if NIPEC is right for you. If you’re told you don’t qualify for NIPEC, you can also get a second opinion.

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NIPEC vs. Chemo or Other Chemo Washes

Each type of chemotherapy used to treat peritoneal mesothelioma works differently. NIPEC, HIPEC and EPIC all have their own pros and cons.

Undergoing NIPEC or EPIC treatments after surgery and HIPEC can lead to better survival rates compared to using chemo alone. Remember, not everyone is eligible for all types of treatment. 

Common Questions About NIPEC for Mesothelioma

Where can I access NIPEC treatment for mesothelioma?

Most mesothelioma treatment centers don’t offer NIPEC as a standard treatment yet. You can receive NIPEC at Moffitt Cancer Center in Tampa, MedStar Washington Hospital Center in D.C., Memorial Sloan Kettering in New York City and Roswell Park in Buffalo. As doctors learn more about NIPEC, more hospitals are starting to offer it along with other treatments like HIPEC. Some people may also get NIPEC in a clinical trial.

Is NIPEC for mesothelioma painful?

NIPEC for mesothelioma can cause pain, but it usually happens less often and is milder than with regular chemo. Since doctors give NIPEC after surgery, you might already feel sore from the operation. Your doctor can give you medicine to help with pain or discomfort. Everyone feels different during treatment, so make sure to tell your care team how you feel. They can change your treatment to help you feel better.

Does insurance cover NIPEC?

Insurance coverage for NIPEC can be different for each person. Since NIPEC isn’t offered at most hospitals yet, coverage depends on your insurance plan and company. Most insurance plans cover common treatments for mesothelioma, but they may not cover treatments that are new or not yet FDA-approved. Some insurance companies might only cover part of NIPEC or may ask for special approval first. Be sure to check with your insurance provider to find out if NIPEC is covered under your plan.

Besides NIPEC, what are some other new treatments for peritoneal mesothelioma?

Doctors are testing new treatments for peritoneal mesothelioma in clinical trials. Some of these include photodynamic therapy, gene therapy and virotherapy. New types of immunotherapy are also being studied, like CAR T-cell therapy, checkpoint inhibitors, lab-made cytokines and mesothelioma vaccines. Researchers are also trying new mixes of chemo drugs, targeted treatments that focus on mesothelioma cells and even electric current therapy to kill cancer cells.

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