PMP RESEARCH FOUNDATION – REPORT FROM THE 9TH INTERNATIONAL CONGRESS ON PERITONEAL SURFACE MALIGNANCIES

PMP Research Foundation – Report from the 9th International Congress on Peritoneal Surface Malignancies

The PMP Research Foundation was proud to once again sponsor and present at the 9th International Congress on Peritoneal Surface Malignancies.  This year’s Congress was held in Amsterdam, Netherlands and hosted by the incomparable Vic Verwaal of the Netherlands Cancer Institute.  PMPRF built upon our participation in the 7th Congress in Uppsala, Sweden (2010) and the 8th Congress in Berlin, Germany (2012).

During this exciting biannual event, we were once again overwhelmed by the passion and commitment that clinical teams from around the world bring to the complex problem of peritoneal surface malignancies, particularly with respect to the “gold standard” of treatment for pseudomyxoma peritonei and appendix cancer: cytoreductive surgery plus heated intraperitoneal chemotherapy (CRS/HIPEC).

Many of this treatment’s pioneers were in attendance—Paul Sugarbaker from the US, Brendan Moran from the UK, Santiago González Moreno from Spain, Marcello Deraco from Italy,David Morris from Australia, Olivier Glehen from France, Yutaka Yonemura from Japan, among others.  We were struck by how far these experts have come in such a short amount of time—developing and further perfecting a treatment that provides favorable outcomes in many patients suffering from a condition that used to be uniformly fatal just a generation ago.  Based on the tireless work by these dedicated professionals, CRS/HIPEC has now been shown to provide long-term survival in up to 90% of patients with low-grade pathology who are properly diagnosed and undergo this treatment early enough in the disease process to offer maximum benefit, and demonstrated overall long-term survival in nearly 2/3 of patients diagnosed with this disease regardless of pathology.  We were especially pleased to see a number of young researchers and clinicians presenting cutting-edge research, providing a foundation for the next generation of understanding and treatment of PMP and appendix cancer.

Despite the progress to date, we know and the experts acknowledge that there is still a lot of work to do.  There was passionate debate regarding a number of unresolved issues at this year’s Congress.  One of the most heated issues involved the ongoing question of the correct terminology to use for these tumors and their various pathologies.  There was a spirited debate on the merits of continuing with the seminal Ronnett pathology construct of “DPAM/PMCA-I/PMCA” or the newer World Health Organization-endorsed “low grade/high grade mucinous carcinoma peritonei” definitions to best describe the spectrum of malignancy that falls under the umbrella of the general diagnosis of PMP and/or appendix cancer.  Both the general session and the nurses’ portion of the meeting brought forth the question of whether “low-grade” PMP or DPAM should be called a cancer at all.  While the terminology debate was certainly not settled at this meeting, it was heartening to see that so many dedicated professionals care enough to bring such passion to their view of what the “right” way to classify the agreed-upon spectrum of malignancy that encompasses PMP and appendix cancer should be.

Along those lines, we were very pleased to sponsor a special pathology session that was dedicated to an extended debate of this important topic.  We are confident that continued progress will be made in this area and lead to agreed-upon terms and definitions that will minimize the confusion that many patients feel when trying to understand and research their condition or discuss it with their medical team, caregivers, families and friends.

Another area identified with much room for improvement was continuity of patient care following CRS/HIPEC, a topic that was addressed by Jerry Lewandowski of PMPRF during an interactive session with the nursing participants.  This presentation was very well received and hopefully we will see some improvement in the after-care of CRS/HIPEC patients following discharge.  We all know that as many patients adjust to a “new normal” following this extensive procedure, they need access to a lot of information and sources of care related to pain management, nutrition, exercise, bowel issues, and other areas.

Much of the congress dealt with PMPRF’s core mission of research related to PMP and appendix cancer. We were thrilled to see research presented that was funded by a past PMP Research Foundation Research Grant awarded to Andrew Renehan and his team at The Christie Hospital in the United Kingdom.  Presenter Darren Roberts did a fine job of explaining the team’s complex research dealing with the molecular characteristics of pseudomyxoma peritonei, and we felt gratified when the team acknowledged that this groundbreaking research would not have been possible without the support of the PMP Research Foundation—and as such, not without the contributions of our supporters over the past six years.

We were also pleased to provide a scholarship that enabled Juan Manuel Medina of Toluca, Mexico to attend and present his research to the congress.  Dr. Medina presented a poster and also spoke to the conference about his treatment of peritoneal surface malignancy caused by a unique type of ovarian cancer.

In addition to the research presented by Dr. Renehan’s team and Dr. Medina, other highlights included:

• Further discussion of the learning curve for the CRS/HIPEC procedure, including some evidence that the learning curve can be improved with strong mentorship from doctors and programs with established peritoneal surface malignancy programs;
• Development of “Nomograms” using data from 31 centers collected over 19 years to better predict prognosis in patients with PMP for use in therapeutic decision-making;
• A proposed new scoring system called “SPAAT” developed to assist in predicting the potential to achieve a complete cytoreduction in patients with low grade mucinous adenocarcinoma of the appendix;
• A lecture by Dr. Sugarbaker on the future of CRS/HIPEC as a potential prophylactic tool to prevent peritoneal surface malignancies; and
• Discussion of finding ways to increase training and mentoring in order to expand access to treatment and establish new centers while minimizing the learning curve for CRS/HIPEC, particularly via University programs and Scientific Societies.

For the first time since the inception of this biennial meeting, the next International Congress on Peritoneal Surface Malignancies will take place in the United States—in Washington, DC.  At the 10th Congress in the fall of 2016, we look forward to once again supporting this important event that brings together so many experts who work on behalf of patients suffering from pseudomyxoma peritonei and appendix cancer.