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First-Line Chemotherapy for Peritoneal Mesothelioma

chemotherapy for peritoneal mesothelioma

The same drugs doctors use to treat pleural mesothelioma can provide effective chemotherapy for peritoneal mesothelioma, too.

Japanese researchers reviewed the cases of 29 peritoneal mesothelioma patients. These patients had first-line treatment with cisplatin and pemetrexed between 2001 and 2016.

The results suggest these drugs are safe and potent chemotherapy for peritoneal mesothelioma. The finding may help doctors and patients make better treatment decisions.

Treating Malignant Mesothelioma

Malignant mesothelioma is a membrane cancer. It usually occurs in one of two places. About 80 percent of mesothelioma tumors arise on the membrane that surrounds the lungs (the pleura). This is called pleural mesothelioma

About 20 percent of the 2,500 cases of mesothelioma diagnosed in the US each year are peritoneal. Peritoneal mesothelioma arises on the membrane that lines the abdomen (the peritoneum). 

The first-line treatment usually recommended for peritoneal mesothelioma is cytoreductive surgery (CRS). This is often followed by a rinse of heated chemotherapy drugs (HIPEC). CRS + HIPEC has improved the outlook for many people with peritoneal mesothelioma.

But not all patients are candidates for this type of chemotherapy for peritoneal mesothelioma. Some tumors are too large or widespread to remove. Patients who are elderly, fragile, or have other underlying medical conditions may also have to forego surgery. 

For these patients, systemic treatment may be the best option.

Types of Chemotherapy for Peritoneal Mesothelioma

HIPEC is a localized chemotherapy for peritoneal mesothelioma. It is administered at the location of the resected mesothelioma tumor while the patient is still on the operating table. 

Systemic chemotherapy for peritoneal mesothelioma goes all throughout the body. It is administered via infusion.   

Right now, doctors do not agree on the best drug combination for peritoneal mesothelioma patients who are not having surgery. One option is to use the same combination doctors use for pleural mesothelioma. Pleura mesothelioma patients usually receive pemetrexed (Alimta) and cisplatin.

In the new study, the Japanese team analyzed the outcomes of this combination of chemotherapy for peritoneal mesothelioma. 

Alimta + Cisplatin Recommended for Peritoneal Mesothelioma

The study included 29 peritoneal mesothelioma patients who received cisplatin and Alimta. It took a median of 7.1 months for their tumors to start growing again after treatment. Their median overall survival was 15.4 months. 

Thirty-eight percent of patients with measurable tumors responded to Alimta/cisplatin chemotherapy for peritoneal mesothelioma.

Twenty-one percent of these patients had a serious drop in their disease-fighting white blood cell levels. But none of the patients died as a result of the treatment. 

The Japanese researchers conclude that the combination of cisplatin and Alimta “can be recommended” as first-line treatment for peritoneal mesothelioma when surgery is not an option.


Nagata, Y, et al, “Efficacy and safety of pemetrexed plus cisplatin as first-line chemotherapy in advanced malignant peritoneal mesothelioma”, July 9, 2019, Japanese Journal of Clinical Oncology, Epub ahead of print, https://academic.oup.com/jjco/advance-article-abstract/doi/10.1093/jjco/hyz104/5530220?redirectedFrom=fulltext

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