Limitations of the PRODIGE 7 trial

Given that 13 (45%) of 29 patients in the cytoreductive surgery plus HIPEC group for whom data were available and 11 (39%) of 28 patients in the cytoreductive group discontinued neoadjuvant chemotherapy because of toxic effects, perhaps this strategy is not suitable for all patients. Patients with a complete or near-complete pathological response to neoadjuvant chemotherapy could derive less benefit from HIPEC than those with a partial response or stable disease.3 In the PRODIGE 7 trial, the addition of HIPEC to cytoreductive surgery led to a significant benefit in relapse-free and overall survival in patients with a PCI of 11–15. Considering that HIPEC acts on microscopic disease, an 18-month survival benefit with a single 30-min HIPEC regimen in patients receiving intense systemic chemotherapy was unlikely. [...]the PRODIGE 7 trial did not show a survival benefit of HIPEC in one subgroup of patients, and the results should not be generalised to all patients with colorectal peritoneal metastases.