Written By: Karen Selby, RN,
Last modified: May 14, 2021

What Is NIPEC?

Normothermic intraperitoneal chemotherapy, or NIPEC, is a room-temperature chemotherapy wash administered through an abdominal port. NIPEC, or NIPEC-LT, is a long-term treatment for malignant peritoneal mesothelioma patients that complements surgery by delivering consistent anti-cancer medication over multiple cycles. 

The current standard of delivering chemotherapy throughout the abdomen is called HIPEC: hyperthermic intraperitoneal chemotherapy. HIPEC chemotherapy is administered warm and only once, during cytoreductive surgery. NIPEC advances this method by extending the anti-cancer effects of surgery and potentially improving disease-free survival.   

Is NIPEC Different Than Conventional Chemotherapy?

For many years, standard oncology chemotherapy has been systemic, which involves administering intravenous anti-cancer drugs through an IV line inserted in a vein or port. Systemic chemotherapy travels throughout your 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. Sometimes called a “chemo bath,” the chemotherapy medication fills and circulates throughout the abdominal cavity to kill cancer cells and reduce the chance of recurrence.

Is NIPEC Better Than Other Chemotherapy Washes?

Current evidence suggests NIPEC is most effective when combined with other forms of chemotherapy washes. 

HIPEC, EPIC and NIPEC are the three primary types of chemotherapy washes used to treat peritoneal mesothelioma, and 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 and is a slightly delayed form of HIPEC given shortly after surgery.
  • NIPEC is normothermic, or room-temperature, intraperitoneal chemotherapy administered regularly for several weeks after surgery.

Patients have exhibited longer survival times when undergoing surgery with HIPEC followed by EPIC and a series of NIPEC treatments. 

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?

Since NIPEC is one of the latest treatments for peritoneal mesothelioma, doctors are still developing the best techniques for administering it. The procedure has shown promising results in treating gastric cancer, ovarian cancer and peritoneal mesothelioma. 

Notably, ovarian cancer and peritoneal mesothelioma are two cancers caused by personal hygiene and industrial products that contain asbestos-contaminated talc. 

Dr. Paul H. Sugarbaker, a pioneer in peritoneal therapy, has worked to position 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, but occurs once patients have recovered from surgery. 

NIPEC Steps

NIPEC administration takes place over several steps. It involves multiple chemotherapy cycles through an abdominal port to kill cancer cells that remain after surgery. In most cases, surgeons will install the port during the initial surgery.

  • 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 from the abdominal or peritoneal cavity.
  • 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.
  • Port Removal: Throughout treatment, 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.

Combining NIPEC with Other Forms of Mesothelioma Treatment

Doctors administer NIPEC after surgery as an adjuvant treatment in a multimodal plan. Multimodal treatment plans, also called multidisciplinary, benefit from many anti-cancer therapy methods working together to eradicate tumors. 

Multidisciplinary approaches have proven to be the best option for improving survival times and the prognosis for mesothelioma

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

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What Is the Success Rate of NIPEC?

One of the best ways to measure mesothelioma treatment success rates is to examine the percentage of patients that live beyond five years, known as the five-year survival rate. 

NIPEC improves peritoneal mesothelioma patients’ five-year survival rate by increasing surgical effectiveness alongside other chemotherapy washes such as HIPEC.

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%

Dr. Paul Sugarbaker’s Innovative Approach to NIPEC Treatment

Over 20 years ago, Sugarbaker helped create the current peritoneal mesothelioma treatment standard of HIPEC. Since then, he’s been able to identify the technique’s shortcomings and has developed NIPEC as the solution. 

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

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 are free of disease after eight, 13, 18 and 19 years, and two patients died of illness 15 years after definitive treatment.

Treatment Centers Offering the NIPEC Procedure

NIPEC is not available as a standard treatment at most mesothelioma treatment centers due to its limited development. 

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 a group of six peritoneal mesothelioma patients who went on to live 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 washes such as NIPEC and HIPEC are usually fewer or milder than with systemic chemotherapy. 

Common Side Effects of NIPEC Treatment

Some common side effects of NIPEC treatment include:
  • Nausea
  • Vomiting
  • Pain
  • Insomnia
  • Weight loss
  • Abdominal pain
  • Diarrhea
  • Constipation
  • Depression

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

Possible complications of NIPEC include:
  • Hemorrhages (bleeding)
  • Sepsis (systemic infection)
  • Pleural effusion
  • Wound infection
  • Kidney failure
  • Bone marrow suppression

While NIPEC offers many benefits to long-term survivability, there can be some disadvantages as well. Patients should discuss the pros and cons with their doctor, as other treatment options may better 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 and may represent the future of peritoneal mesothelioma therapy. Combining long-term NIPEC with other chemotherapy washes has led to 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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