| | | | |

PIPAC May Make More Patients Candidates for Mesothelioma Surgery

ByAlex Strauss
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

Similar Posts

  • | |

    Doctors Describe "Concrete Therapeutic Approach" for Mesothelioma

    ByAlex Strauss

    A team of medical researchers in Italy have achieved what they are calling “excellent” tumor control and survival results in malignant pleural mesothelioma patients using a combination of surgery, chemotherapy, and radiotherapy. Caused by exposure to asbestos, mesothelioma typically spreads quickly across the lung-encasing membrane called the pleura. There is no known cure but treatments are improving. In the current prospective study, 20 malignant pleural mesothelioma patients underwent radical pleurectomy/decortication followed by high doses of radiation. After surgeons removed as much of the visible mesothelioma tumor and surrounding tissue as possible, patients received 50Gy of radiation to the effected side of their chest, delivered in 25 fractions. Regions of particular concern for mesothelioma regrowth got an extra radiation “boost” to…

  • |

    Mesothelioma Still Rising Despite Ban in Ireland

    ByAlex Strauss

    A study in Ireland confirms that it can take many years for a ban on asbestos to have a measurable impact on a country’s rates of malignant mesothelioma. Mesothelioma is the most serious of a list of diseases – including lung cancer, pleural plaques, asbestosis, and others – linked with exposure to asbestos dust. Affecting the linings around the lungs and other organs, mesothelioma is often resistant to most cancer treatments and may be fatal within a year of diagnosis. According to the International Ban Asbestos Secretariat, Ireland is one of 55 countries that have enacted some type of asbestos ban. However, although Ireland banned asbestos in 2000, a new study published in Cancer Epidemiology shows that incidence of the…

  • | |

    Does Radiotherapy Reduce Mesothelioma Pain?

    ByAlex Strauss

    A new study says there is not enough evidence to support the use of radiotherapy for the treatment of pain associated with malignant pleural mesothelioma. Researchers at the University of Edinburgh in Scotland reviewed a range of past studies on mesothelioma pain and radiotherapy by searching databases that date back as far as 1974. To be eligible to be included in their review, the study had to focus on malignant pleural mesothelioma and radiotherapy given “with the intent of improving pain”. The study also had to report doses and fractionation of the radiotherapy and how the pain responded. In all, the researchers found eight studies on mesothelioma pain and radiotherapy that met the criteria. Two of the studies were prospective…

  • |

    Website Aims to Protect Homeowners from Mesothelioma

    ByAlex Strauss

    Australia’s Cancer Council is trying to educate home renovators about their risk for mesothelioma with a new e-learning course. Australia has one of the highest per capita rates of mesothelioma in the world, largely because of several asbestos mining operations that were once located there. Although asbestos has been banned from building products in Australia since 1989, asbestos-linked diseases like mesothelioma, lung cancer, and asbestosis continue to pose a serious health concern. While mesothelioma has traditionally occurred among people exposed to asbestos on the job, Australia is now bracing for another “wave” of mesothelioma victims among homeowners who encounter asbestos while doing their own renovation projects. Cancer Council Australia has launched “kNOw asbestos in your home” in an effort to…

  • |

    Ape Virus Shrinks Mesothelioma Tumors in Lab

    ByAlex Strauss

    A virus that causes leukemia in gibbon apes may have the power to help fight malignant mesothelioma in people. Gibbon ape leukemia virus (GALV) has been tested for years as a viral vector, a carrier of therapeutic genetic information, in the treatment of various human illnesses, including cancer. A new study in Japan compared GALV with a leukemia virus derived from mice to see which carrier communicated most efficiently with mesothelioma cells. While both types of viruses replicated in most of the mesothelioma cell lines tested, the mouse-derived virus was not effective in a mesothelioma cell line called ACC-MESO-1. In this cell line, only the GALV spread efficiently both in culture and in mice that had been given human mesothelioma…

  • | |

    Radiotherapy for Mesothelioma: Better But Still Limited

    ByAlex Strauss

    A form of highly-targeted radiation therapy for mesothelioma is better than it used to be, but is still risky. That is the message of a recent article on intensity-modulated radiation therapy (IMRT) in Seminars in Thoracic and Cardiovascular Surgery. Author Kenneth E. Rosenzweig, MD, a Radiation Oncologist with Mount Sinai Hospital in New York, reviewed recent studies on IMRT and mesothelioma. He concludes that, while the “troubling toxicity” associated with IMRT when it was first introduced has not been entirely eliminated, the fact that clinicians now have more experience with it is making a positive difference for mesothelioma patients. Before targeted therapies like IMRT were available, high-dose radiation was not usually a feasible option for mesothelioma since the irregular shape…