Mesothelioma and Intraperitoneal Chemotherapy
Combining aggressive surgery with chemotherapy delivered directly into the abdominal cavity may significantly extend survival in patients with peritoneal mesothelioma, according to a consensus statement of peritoneal mesothelioma specialists published in the September 15 issue of the Journal of Surgical Oncology.
Reaching a consensus on the treatment of peritoneal mesothelioma—a cancer that affects the abdominal lining—has been difficult for doctors, because the disease progresses so quickly and conventional treatments such as surgery and chemotherapy have done little in the past to stall its progress and improve survival. However, new therapies are showing great promise, and are vastly improving the outlook for patients with this cancer.
Among the most promising of these therapies is combining aggressive surgery to remove as much cancer as possible (cytoreduction) with chemotherapy delivered directly into the abdominal cavity (perioperative intraperitoneal chemotherapy — PIC). Sometimes that chemotherapy is heated (hyperthermic intraperitoneal chemotherapy, or HIPEC).
More than half of patients treated with this combination therapy have lived for at least five years, compared with an average survival of only one year in patients treated with traditional surgery and/or chemotherapy. The experts surveyed for the consensus statement said the most effective intraperitoneal chemotherapy regimen combines the platinum-based chemotherapy drug cisplatin with doxorubicin.
Before patients can undergo any treatment, they should first be evaluated with diagnostic studies such as a CT scan of the abdomen (an x-ray technique that produces detailed images), and a biopsy to analyze the cells for cancer. Knowing the tumor size, location, and subtype can help doctors exclude patients who would not benefit from undergoing potentially risky surgery, says lead study author Marcello Deraco, MD, of the Fondazione IRCCS Istituto Nazionale Tumori Milano in Milan, Italy. Patients whose cancer has spread outside of the abdomen, or whose tumor is larger than 5 centimeters may not be appropriate candidates for surgery.
The study authors mention several new techniques that are helping doctors more accurately diagnose, and more precisely treat peritoneal mesothelioma. Studying tumor genes with genetic microarray techniques is helping doctors better distinguish malignant mesothelioma from lung cancer. Microarrays may also help predict how well patients will respond to drugs.
New treatments such as immunotherapy (which stimulates the patient’s own body to fight off the cancer), gene therapy, and anti-angiogenesis drugs (which prevent the growth of blood vessels that feed cancer) may improve the outlook even more for peritoneal mesothelioma patients in the future.
For now, referring patients to medical centers that specialize in cytoreduction surgery and intraperitoneal chemotherapy can offer the best possible hope for peritoneal mesothelioma patients, Dr. Deraco says.
Source:
Deraco M, Bartlett D, Kusamura S, Baratti D. Consensus statement on peritoneal mesothelioma. J Surg Oncol. 2008;98:268-272.Combining aggressive surgery with chemotherapy delivered directly into the abdominal cavity may significantly extend survival in patients with peritoneal mesothelioma, according to a consensus statement of peritoneal mesothelioma specialists published in the September 15 issue of the Journal of Surgical Oncology.
Reaching a consensus on the treatment of peritoneal mesothelioma—a cancer that affects the abdominal lining—has been difficult for doctors, because the disease progresses so quickly and conventional treatments such as surgery and chemotherapy have done little in the past to stall its progress and improve survival. However, new therapies are showing great promise, and are vastly improving the outlook for patients with this cancer.
Among the most promising of these therapies is combining aggressive surgery to remove as much cancer as possible (cytoreduction) with chemotherapy delivered directly into the abdominal cavity (perioperative intraperitoneal chemotherapy — PIC). Sometimes that chemotherapy is heated (hyperthermic intraperitoneal chemotherapy, or HIPEC).
More than half of patients treated with this combination therapy have lived for at least five years, compared with an average survival of only one year in patients treated with traditional surgery and/or chemotherapy. The experts surveyed for the consensus statement said the most effective intraperitoneal chemotherapy regimen combines the platinum-based chemotherapy drug cisplatin with doxorubicin.
Before patients can undergo any treatment, they should first be evaluated with diagnostic studies such as a CT scan of the abdomen (an x-ray technique that produces detailed images), and a biopsy to analyze the cells for cancer. Knowing the tumor size, location, and subtype can help doctors exclude patients who would not benefit from undergoing potentially risky surgery, says lead study author Marcello Deraco, MD, of the Fondazione IRCCS Istituto Nazionale Tumori Milano in Milan, Italy. Patients whose cancer has spread outside of the abdomen, or whose tumor is larger than 5 centimeters may not be appropriate candidates for surgery.
The study authors mention several new techniques that are helping doctors more accurately diagnose, and more precisely treat peritoneal mesothelioma. Studying tumor genes with genetic microarray techniques is helping doctors better distinguish malignant mesothelioma from lung cancer. Microarrays may also help predict how well patients will respond to drugs.
New treatments such as immunotherapy (which stimulates the patient’s own body to fight off the cancer), gene therapy, and anti-angiogenesis drugs (which prevent the growth of blood vessels that feed cancer) may improve the outlook even more for peritoneal mesothelioma patients in the future.
For now, referring patients to medical centers that specialize in cytoreduction surgery and intraperitoneal chemotherapy can offer the best possible hope for peritoneal mesothelioma patients, Dr. Deraco says.
Source:
Deraco M, Bartlett D, Kusamura S, Baratti D. Consensus statement on peritoneal mesothelioma. J Surg Oncol. 2008;98:268-272.
