Personalized Chemotherapy for Abdominal Cancer: A Q&A with Kiran Turaga

Kiran Turaga, MD, MPH: This is the foundation of my entire clinical practice, and it's been done for over 20 years. The concept is intuitive—if the cancer tends to spread within the peritoneum but not widely to other organs, why not put the chemotherapy right there?

When you deliver it intraperitoneally, it's heated, which helps it penetrate the vasculature better. Patients can also receive higher concentrations with fewer side effects, and many go home the same day.

The challenge has always been that the chemotherapy we put into the abdomen isn't always personalized, so it isn't always effective. Some randomized trials have shown significant benefit for intraperitoneal therapy, while others have not. That mixed messaging is exactly what needs to be resolved.

Turaga: This trial is for patients who have peritoneal metastases but are not candidates for surgery—meaning the cancer has spread too extensively to be surgically removed. For these patients, we deliver intraperitoneal chemotherapy in a targeted manner.

We use a technology called Travera to personalize the chemotherapy that goes into the abdomen. We take fresh tissue from the patient's tumor and send it to the lab. Travera measures the weight of individual cancer cells at the picogram level. When chemotherapy is introduced to the cells, dying cells undergo apoptosis and their weight changes. A large change in weight signals significant cell death—meaning that the drug is likely to be effective for that patient. A minimal change means the drug probably isn't working. So this is a way for us to test how well various treatments might work for a patient before we give one to them.

What's remarkable is that we get results back from Travera in 48 hours. This speed matters enormously because it means we can act on the results in a clinically meaningful timeframe. If this proves to be effective, then I think that would really be a game-changer for patients and providers.

Turaga: I see three big changes coming. First, our ability to detect peritoneal metastases earlier is improving dramatically, and in 10 years, I believe we'll be able to detect these much sooner than we can today.

Second, for the first time, there are signals that we can actually prevent peritoneal metastases in patients who have been diagnosed with gastrointestinal cancers—not just treat them after the fact. The work we're doing now on chemosensitivity testing may help us identify low-toxicity, low-morbidity chemotherapy regimens that reduce recurrence.

Third, I'd love to see a world where every patient undergoing cancer surgery is enrolled in a trial, and where we have a vibrant, sustainable pipeline of undergraduates and trainees deeply engaged in this work. We've been working on cancer for 50 years, and we're still making progress, but I genuinely believe that if we can build the right collaborative infrastructure, we can accelerate that timeline significantly. Yale has been essential to this because the spirit of discovery here is woven into the institution itself and the people.