There is evidence that repeatedly rinsing the abdomen with medicine might lead to longer mesothelioma survival after surgery.
A rinse of heated chemotherapy drugs during surgery has become standard of care for peritoneal mesothelioma. Unfortunately, mesothelioma usually comes back.
But a top mesothelioma doctor says longer mesothelioma survival might be possible if patients got regular chemotherapy “rinses” through a catheter. Studies show the drugs may not even have to be heated to work.
Longer Mesothelioma Survival After Surgery
Peritoneal mesothelioma is a type of asbestos cancer. It starts on the lining around the abdomen and can spread to other parts of the body. About a fifth of mesothelioma patients have this type.
Heated intraperitoneal chemotherapy (HIPEC) has led to longer mesothelioma survival for many people with peritoneal tumors.
First, surgeons remove as much cancer as possible. Then, chemotherapy drugs are rinsed around the abdomen before the incision is closed. The goal is to kill any remaining mesothelioma cells that might give rise to new tumors.
The HIPEC treatment is typically only done once, during mesothelioma surgery. But evidence now suggests that repeating the procedure could lead to even longer mesothelioma survival.
NIPEC Could Improve Mesothelioma Surgery Outcomes
This alternate approach to mesothelioma chemotherapy is called NIPEC-LT. NIPEC stands for normothermic [unheated] intraperitoneal chemotherapy. The LT means that it is delivered repeatedly over the long-term for longer mesothelioma survival.
In a study of the technique, three groups of patients had cytoreductive surgery for cancers in the abdomen. The first two groups underwent HIPEC or HIPEC plus one additional dose of intraperitoneal chemotherapy (EPIC) shortly after surgery.
The third group of 29 patients got HIPEC, EPIC and six months of NIPEC. These patients had a catheter inserted in their abdomens during surgery. Some patients received paclitaxel during their NIPEC treatments and the rest got pemetrexed (Alimta).
“Over a 20 year time span these 3 groups of patients adding EPIC to HIPEC showed no significant improvement; however, a statistically significant increase in survival resulted when multiple cycles of NIPEC-LT were initiated,” wrote study author Paul H. Sugarbaker of MedStar Washington Hospital Center in Washington, DC.
NIPEC is routinely used in the treatment of ovarian cancer. Since the first studies of NIPEC-LT for mesothelioma, doctors have seen much longer mesothelioma survival in some patients.
“The aggressive surgical approach plus regional chemotherapy has increased the median survival to more than 5 years,” writes Dr. Sugarbaker. “With NIPEC-LT added on, 70% 5-year survival has been reported.”
Sugarbaker, Paul, “Update on the management of malignant peritoneal mesothelioma”, October 2018, Translational Lung Cancer Research, http://tlcr.amegroups.com/article/view/23788/18535
Sugarbaker, Paul, “Normothermic intraperitoneal chemotherapy long term (NIPEC-LT) in the management of peritoneal surface malignancy, an overview”, Pleura and Peritoneum, https://www.degruyter.com/view/j/pp.2017.2.issue-2/pp-2017-0012/pp-2017-0012.xml