Abstract: FR-PO1272
A Case of Thrombotic Microangiopathy After Pressurized Intraperitoneal Aerosolized Chemotherapy with Mitomycin C
Session Information
- Onconephrology: Diagnostic Dilemmas, Therapy-Related Toxicities, and Clinical Cases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Authors
- Long, Elizabeth, Inova Fairfax Hospital, Falls Church, Virginia, United States
- Regunathan-Shenk, Renu, Inova Fairfax Hospital, Falls Church, Virginia, United States
Introduction
Appendiceal adenocarcinoma is a rare cancer that often presents with widespread dissemination to the peritoneum. Standard treatment includes cytoreduction surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a novel therapy for advanced peritoneal cancers being studied in clinical trials. Use of mitomycin C (MMC) in PIPAC has not been extensively studied, but is favored due to its hydrophilic nature and pharmacologic stability, as well as its direct cytotoxicity after short exposure. HIPEC MMC doses vary from 10mg/m2 to 35 mg/m2, compared to IV dose of 10 mg/m2. Known side effects of systemic MMC administration include myelosuppression, pulmonary toxicity, and thrombotic microangiopathy (TMA). We present a patient (Pt) with MMC-induced TMA from PIPAC used to treat metastatic appendiceal adenocarcinoma.
Case Description
59 year old Pt with history of metastatic appendiceal adenocarcinoma treated with FOLFIRI (folinic acid, fluorouracil, irinotecan) and bevacizumab, then PIPAC with MMC presented for evaluation of elevated creatinine (Cr). He had 3 cycles of PIPAC before it was discontinued due to suspected MMC-induced pneumonitis, treated with 2 months of prednisone. He had not received MMC for 3 months when he was noted to have Cr of 2.6 mg/dL from baseline 0.8 mg/dL. Laboratory findings included platelet count of 190 x 103/uL, hemoglobin of 8.2 g/dL, urinalysis with 2+ protein, small blood, and 11-25 hyaline casts with no cells, urine protein/Cr ratio 1.9 g/d, and urine microalbumin/Cr ratio 1,440 ug/mg. Total bilirubin was 0.7 mg/dL. Other serological evaluation was unremarkable. Renal biopsy showed thickened glomeruli with segmental duplication of the basement membrane, mesangiolysis, and subendothelial lucency consistent with chronic TMA. There was also evidence of arteriolosclerosis, arteriosclerosis, and acute tubular injury.
Discussion
The incidence of HUS in patients receiving systemic MMC is less than 15%.3 We present a case of MMC-induced TMA in a Pt who received locoregional therapy of MMC for appendiceal cancer using PIPEC, a novel therapy for advanced peritoneal cancers. This is the first reported TMA from PIPAC administered MMC. TMA can occur at any point during and following MMC administration and should be considered in any patient who develops AKI after receiving this drug.