German doctors testing the HITHOC treatment for pleural mesothelioma say it is a “safe therapeutic option”. The key to success is careful patient selection.
Pleural mesothelioma is a rare cancer linked to asbestos. Tumors grow on the membrane that surrounds the lungs. Doctors have not yet found a cure for mesothelioma.
HITHOC treatment involves rinsing heated chemotherapy drugs through the chest after mesothelioma surgery. The new study suggests that this advanced approach may help certain mesothelioma patients live longer.
Understanding Pleural Mesothelioma Tumors
To understand how HITHOC treatment works, it is important to understand how and where mesothelioma tumors grow.
Pleural mesothelioma tumors start on the lining around the lungs called the pleura. As tumors grow, the pleura thickens and becomes less pliable. This can make it difficult for patients to take a deep breath. Eventually, cancer cells can spread from the pleura to the lungs and other organs.
The irregular shape and location of pleural tumors makes mesothelioma surgery challenging. Even when the surgeon is as thorough as possible, it is common for some cancer cells to be left behind in the chest. These cancer cells can “seed” new tumors.
HITHOC treatment attempts to kill residual mesothelioma cells. The heated liquid can get into areas of the chest cavity that the surgeon cannot reach or even see. The goal is to keep pleural mesothelioma from coming back.
HITHOC Treatment Works Better in Some Patients Than Others
The German study included 71 pleural mesothelioma patients who had surgery between 2009 and 2013. The median patient age was 70, which is about average for pleural mesothelioma diagnosis. In all cases, the patients’ tumors were confined to one area of the chest.
Surgeons removed the diseased pleural lining and as much cancerous tissue as they could see. Patients then got HITHOC treatment with a combination of cisplatin and doxorubicin.
Some patients lived much longer than others after HITHOC treatment. Those who had epithelioid mesothelioma, the most common subtype, lived for a median of 17.9 months. But patients with the rarer sarcomatoid subtype had a poor median survival of just 9.2 months.
Not surprisingly, patients whose surgeries were the most complete had much better survival than those where some of the tumor could not be removed. After complete resection and HITHOC treatment, median survival was 28.2 months. Incomplete resection resulted in a median survival of just 13.1 months.
Lead study author Laura Klotz of the University of Munich concludes that HITHOC treatment is a “safe therapeutic option” for epithelioid mesothelioma patients. It is most likely to be effective in patients with tumors confined to one area.
Klotz, LV, et al, “Pleurectomy/decortication and hyperthermic intrathoracic chemoperfusion using cisplatin and doxorubicin for malignant pleural mesothelioma”, May 2019, Journal of Thoracic Disease, pp. 1963- 1972, http://jtd.amegroups.com/article/view/28750/21248