PIPAC May Make More Patients Candidates for Mesothelioma Surgery

Researchers in France have come up with a way to turn some people with inoperable peritoneal mesothelioma into good candidates for mesothelioma surgery. 

They are using a new technique to spray chemotherapy drugs directly onto peritoneal tumors in order to shrink them. 

In some cases, the technique shrunk mesothelioma tumors enough that they could be surgically removed with the CRS/HIPEC procedure. 

What Makes a Good Candidate for Mesothelioma Surgery

A number of factors influence whether patients are good candidates for mesothelioma surgery. Patients have to be in otherwise reasonably good health so that their body can handle the surgery. It is also critical that their mesothelioma not be so widespread in their abdomen that it would be impossible for surgeons to remove. 

In a new study, French doctors analyzed the cases of 146 patients who had the spray-on drugs for peritoneal cancer. Twenty-six of the patients had tumors that were too big to remove right away.

These patients each had several sessions of spray-on chemotherapy. The goal was to reduce the tumor burden enough so that they could become better candidates for mesothelioma surgery.

How Spray-on Chemotherapy Works

The technical name for the new “spray-on” chemotherapy technique is PIPAC. PIPAC stands for pressurized intraperitoneal aerosol chemotherapy. 

With PIPAC, surgeons insert a spraying device called a nebulizer into the abdomen through an incision. Using an internal camera for guidance, they spray a cocktail of chemotherapy drugs onto the peritoneal mesothelioma tumor. 

PIPAC is similar to the more common heated intraperitoneal chemotherapy (HIPEC) technique that is often used alongside cytoreductive surgery (CRS). 

With HIPEC, doctors rinse heated drugs through a patient’s abdomen immediately after CRS. For patients who are good candidates for mesothelioma surgery, the CRS/HIPEC technique appears to offer the best odds of mesothelioma survival. 

If a peritoneal tumor is too large or widespread for CRS/HIPEC, PIPAC may function as a sort of bridge to surgery.

Preparing Candidates for Mesothelioma Surgery with PIPAC

In the French study, patients with various types of peritoneal cancer each had several sessions of PIPAC.  The average number of PIPAC session was three but some patients had as many as eight before they were considered candidates for mesothelioma surgery. Patients had systemic chemotherapy between PIPAC sessions.

None of the patients had major complications from PIPAC, although a small percentage had less serious complications. 

Out of the 26 patients who had PIPAC while they waited for surgery, 21 eventually experienced complete removal of their tumors. Five were still considered unresectable. 

At a median follow-up of 7 months, 76 percent of those 21 patients were still alive. Fourteen patients had no recurrence of their cancer during that time. The researchers conclude that PIPAC may help “strictly selected” patients become candidates for mesothelioma surgery.

Source:

Alyami, M, et al, “Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy”, June 21, 2019, European Journal of Surgical Oncology, Epub ahead of print, https://linkinghub.elsevier.com/retrieve/pii/S0748798319305220