Long Term Peritoneal Mesothelioma Survival with NIPEC

A new report suggests that long term peritoneal mesothelioma survival may be possible with a treatment called NIPEC and the drug paclitaxel. 

NIPEC stands for normothermic intraperitoneal chemotherapy. It is similar to the heated chemotherapy that many peritoneal mesothelioma patients now get. But NIPEC is delivered through a catheter over time and at room temperature. 

The new article details the long term peritoneal mesothelioma survival of six patients on NIPEC with paclitaxel. It comes from one the nation’s leading experts in this form of mesothelioma, Paul Sugarbaker, MD. 

Even though the sample size is small, Dr. Sugarbaker says the results are impressive enough to warrant further study. 

HIPEC and Mesothelioma Treatment

Peritoneal mesothelioma accounts for about 20 percent of mesothelioma cases. Most patients worked with or near asbestos and swallowed some of the microscopic fibers. 

Peritoneal mesothelioma starts on the lining that surrounds the abdominal organs. It can quickly spread throughout the abdomen. Diffuse peritoneal mesothelioma occurs in multiple places in the abdomen. 

Like other forms of asbestos cancer, diffuse peritoneal mesothelioma is not curable. Long term peritoneal mesothelioma survivors are rare.  

But the prognosis is better than it used to be thanks to HIPEC. HIPEC is a heated chemotherapy solution. Surgeons use it to rinse the abdomen after surgery. The goal is to kill any remaining cancer cells that could turn into new mesothelioma tumors. 

Unlike systemic chemotherapy which travels all through the body, HIPEC stays in the abdomen. This can mean fewer chemotherapy side effects. The median survival for peritoneal mesothelioma patients who have surgery and HIPEC is about five years. 

Improving the Odds of Long Term Peritoneal Mesothelioma Survival

In his new article, Dr. Sugarbaker and his colleague, O. Anthony Stuart, detail six remarkable cases of long-term peritoneal mesothelioma survival. The patients received a variation on the HIPEC concept called NIPEC.

After surgery and HIPEC, doctors used NIPEC to deliver several doses of the drug paclitaxel. 

Like HIPEC, medicine delivered with NIPEC stays in the abdomen. Unlike HIPEC, NIPEC requires no heating and occurs repeatedly. Patients get the drug through a catheter that stays in place. 

Of the six peritoneal mesothelioma patients, four are still alive. They are disease free at 8, 13, 18, and 19 years. Both of the patients who died lived for 15 years after treatment. Such long term peritoneal mesothelioma survival is unusual. Dr. Sugarbaker is cautiously optimistic. 

“The small number of patients treated with repeated doses of intraperitoneal paclitaxel cause these data to be interpreted with caution,” he writes. “However, the long-term benefit and favorable pharmacology of these patients suggests the need for further study.”

About 500 patients are diagnosed with peritoneal mesothelioma in the US each year. 

Source:

Sugarbaker, P and Stuart, O.A., “Unusually favorable outcome of 6 consecutive patients with diffuse malignant peritoneal mesothelioma treated with repeated doses of intraperitoneal paclitaxel. A case series”, June 2020, Surgical Oncology, pp. 96-99, https://www.sciencedirect.com/science/article/abs/pii/S096074041930533X?via%3Dihub