Case 1

A 58-year-old woman with advanced-stage ovarian cancer underwent optimal debulking surgery in August 2005. She subsequently completed 6 cycles of paclitaxel (175 mg/m ² ) and carboplatin (5 area under the curve [AUC]), from which she obtained a complete response.

In February 2007, the patient exhibited progressive disease and reinitiated paclitaxel and carboplatin chemotherapy. During cycle 7, the patient experienced a grade-2 HSR, characterized by bronchospasms and palmar erythema; hydrocortisone sodium succinate (100 mg) was provided and her symptoms resolved.

In January 2013, the patient developed recurrent disease and was slated for 1 cycle of HIPEC. Initially, similar to the patient’s previous intravenous therapy, premedications comprising palonosetron (0.25 mg) and dexamethasone (8 mg) were administered. A 4-cm midline skin incision was made and carried through the abdominal layers; a GelPort (Applied Medical Resources, Rancho Santa Margarita, CA) system was then placed in the abdominal incisions.

The 2 inflow and outflow tubes for the HIPEC ThermoChem HT-1000R device (ThermaSolutions Inc, St Paul, MN) were positioned intraabdominally. Carboplatin (8 AUC) was mixed in 2500 mL of normal saline and then added to the inflow fluid. Thereafter, continuous circulation of the infusate was maintained with a change in temperature of 1.0-1.5°C for 90 minutes until a uniform intraperitoneal temperature of 41.5°C was attained.

When the procedure concluded, the chemotherapy-containing infusate was completely removed and the abdominal cavity was flushed with 2 L of lactated Ringer’s solution. The patient had an uncomplicated intraoperative and postoperative course. The patient was neither rechallenged with carboplatin nor did she undergo a chemotherapy desensitization protocol.

Case 2

A 59-year-old woman with advanced-stage ovarian carcinoma underwent optimal tumor debulking surgery in February 2013. She was treated with 6 cycles of weekly paclitaxel (80 mg/m ² ) and monthly carboplatin (6 AUC) to which she obtained a complete response; following cycle 6, the patient developed a grade-2 HSR, which resulted in angina pectoris, tachycardia, asthenia, palmar erythema, and allergic rhinitis. She received hydrocortisone sodium succinate (100 mg), and her symptoms promptly resolved.

Despite the HSR, she was considered for 1 cycle of consolidation HIPEC with the intent to sustain her remission; as in case 1, the patient was initially treated with palonosetron and dexamethasone premedication. Subsequently, carboplatin (8 AUC) was administered in accordance with physician discretion. Following treatment, she had an uncomplicated intraoperative/postoperative course and has since remained disease free. Moreover, there was no intention to ultimately rechallenge the patient with carboplatin or employ chemotherapy desensitization.

Case 3

A 62-year-old woman with advanced-stage ovarian carcinoma underwent optimal debulking surgery in April 2010. The patient received 6 cycles of weekly adjuvant paclitaxel (80 mg/m ² ) and monthly carboplatin (6 AUC) chemotherapy, to which she achieved a complete clinical response.

In March 2012, the patient exhibited recrudescent disease and began paclitaxel (175 mg/m ² ) and carboplatin (6 AUC) chemotherapy; however, upon starting cycle 5, the patient developed a grade-2 HSR, characterized by palmar erythema; following intravenous diphenhydramine (50 mg), the patient’s condition dramatically improved.

In July 2013, the disease recurred again and the patient underwent debulking surgery, of which only miliary disease remained. Following palonosetron and dexamethasone therapy, 1 cycle of HIPEC with carboplatin (10 AUC) was administered; the patient experienced an uncomplicated intraoperative/postoperative course. Henceforth, the patient was neither scheduled for platinum retreatment nor chemotherapy desensitization.