HITOC for Mesothelioma: Benefits May Outweigh the Risk

The benefits of a localized chemotherapy regimen known as HITOC for mesothelioma outweigh the small risk of kidney failure for most patients. 

That is the conclusion of a new study published in the journal Cancers. German researchers conducted a retrospective review of the medical literature on HITOC (also called HITHOC) in pleural mesothelioma patients. 

They were most interested in patients who developed kidney problems after the procedure. This is a known risk with HITOC for mesothelioma. But the study suggests that most patients benefit from this type of chemotherapy in spite of the risk.

Localized Treatment Versus Systemic Treatment

Pleural mesothelioma tumors start on the membrane around the lungs and are hard to treat. Once this cancer takes hold, most patients face a poor prognosis. Mesothelioma cells are resistant to most conventional cancer treatments, including systemic chemotherapy.

Systemic treatments are those that go through the whole body. Systemic chemotherapy with Alimta is a common treatment for mesothelioma. But it can also make patients very sick since it attacks both cancer cells and normal cells. 

HITOC for mesothelioma is different. While the patient is still in surgery, surgeons rinse the chest cavity with a heated solution of chemotherapy drugs. With this approach, the drugs only touch the area right around the tumor. 

HITOC makes it possible to use higher doses of chemotherapy drugs. Higher doses may be more effective against mesothelioma tumors. The downside of HITOC for mesothelioma is that the kidneys, which help to clear the body of foreign substances, are still affected. 

Evaluating HITOC for Mesothelioma

The goal of the new German study was to evaluate HITOC and its side effects. It included 261 patients with malignant pleural mesothelioma. It also included 89 patients with other kinds of cancer on the pleural membrane.

Patients underwent either pleurectomy with decortication (P/D) or extrapleural pneumonectomy (EPP). P/D surgery leaves both lungs intact while EPP removes one lung.

Patients received HITOC for mesothelioma with either cisplatin alone or a combination of cisplatin and doxorubicin. Some patients got high doses of cisplatin while others got low doses. 

“Postoperative renal insufficiency appeared in 12% of the patients and 1.4% required temporary dialysis,” writes Dr. Michael Ried of University Hospital Regensburg. “Patients receiving high-dose cisplatin were 2.7 times more likely to suffer from renal insufficiency than patients receiving low-dose cisplatin.”

In the German study, 3.7% of treated patients died in the hospital. But, in most cases, kidney problems that develop after HITOC for mesothelioma are only temporary. The study concludes that the risk was “within an acceptable range”.

Advanced treatments like P/D, EPP, and HITOC are not available everywhere. They are usually offered at large cancer centers that have more experience with mesothelioma. CLICK HERE if you need help finding a mesothelioma expert in your area. 

Source: 

Ried, M, et al, “Hyperthermic Intrathoracic Chemotherapy (HITOC) after Cytoreductive Surgery for Pleural Malignancies-A Retrospective, Multicentre Study”, September 12, 2021, Cancers, https://www.mdpi.com/2072-6694/13/18/4580