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Treating Advanced Peritoneal Mesothelioma with Spray-On Oxaliplatin

ByAlex Strauss
advanced peritoneal mesothelioma surgeon

European doctors have tested a new spray-on cancer drug that could be another treatment option for people with advanced peritoneal mesothelioma.

The drug is oxaliplatin. It is sold under the brand name Eloxatin. It is normally given by injection into a vein. But that can cause serious side effects, including stomach pain.

A new study published in the European Journal of Surgical Oncology suggests there may be a more effective way to get the benefits of oxaliplatin. Researchers found that using it as a spray for advanced peritoneal mesothelioma extended survival with fewer side effects.

PIPAC for Advanced Peritoneal Mesothelioma

As Surviving Mesothelioma first reported last spring, pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new way to deliver cancer medicines.

During PIPAC, mesothelioma chemotherapy drugs are “sprayed” as gas directly onto the site of the cancer. This allows the application to be very precise. PIPAC is performed through a small incision using a laparoscope for guidance.

Potential advantages of PIPAC for advanced peritoneal mesothelioma patients are:

  • Less risk of pain and infection than an open procedure
  • May be repeated to maintain cancer control
  • Aerosol droplets may be absorbed into the tissue better than liquid medicine
  • More precise than systemic chemotherapy or even HIPEC so side effects are lessened
  • Usable in patients who are not candidates for surgery and heated intraperitoneal chemotherapy (HIPEC) treatment

These factors can make PIPAC a better option for delivering certain kinds of cancer drugs. Right now, PIPAC is still in clinical trials. But European doctors have already used it to treat thousands of patients with recurrent advanced peritoneal mesothelioma.

Delivering Oxaliplatin with PIPAC

Oxaliplatin is a platinum-based drug that is most often used to treat colorectal cancer. It is believed to work by making it impossible for cancer cells to duplicate their DNA.

In the newest PIPAC study, a team of French and Swiss doctors gave oxaliplatin to people with several kinds of peritoneal cancer including advanced peritoneal mesothelioma.

If they are not candidates for surgery, peritoneal mesothelioma patients have few good treatment options. The goal of the new study was to see if PIPAC would make oxaliplatin treatment easier for mesothelioma patients and others to tolerate.

Promising Results for Advanced Peritoneal Mesothelioma Patients

More than 100 patients with unresectable peritoneal cancer received the PIPAC-Ox treatment. Twenty-three patients reported abdominal pain, but only 9 had pain so bad that they had to change drugs.

Patients had an average of 2.5 procedures each. About a third of them saw improvements in their cancer symptoms.

The researchers conclude that PIPAC-Ox “appears to be a safe treatment that offers good symptom control and promising survival” for patients with advanced peritoneal mesothelioma and other peritoneal cancers.

Source:

Sgarbura, O, et al, “Oxaliplatin use in pressurized intraperitoneal aerosol chemotherapy (PIPAC) is safe and effective: A multicenter study”, May 9, 2019, European Journal of Surgical Oncology, Epub ahead of print, https://www.ejso.com/article/S0748-7983(19)30445-7/fulltext

Giger-Pabst, U, et al, “Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for the treatment of malignant mesothelioma”, April 18, 2018, BMC Cancer, https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-4363-0

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