Administering the chemotherapy drug paclitaxel directly into the abdomen of people with mesothelioma might offer a way to prevent metastatic peritoneal mesothelioma.
That is the premise of a recent article by Dr. Paul Sugarbaker in the Journal of Gastrointestinal Oncology. Dr. Sugarbaker is a global expert in peritoneal mesothelioma. He works at MedStar Washington Hospital in Washington, DC.
Metastatic peritoneal mesothelioma is when mesothelioma cells spread. They move from their original spot to other parts of the abdomen.
Paclitaxel can help prevent new tumors in people who already have some metastases. In his new article, Dr. Sugarbaker says the evidence suggests that it might also work to keep metastases from forming.
Metastatic Peritoneal Mesothelioma Treatment
Malignant mesothelioma is a cancer of internal membranes. It usually comes from exposure to asbestos. Most people think of pleural mesothelioma when they think of mesothelioma. Pleural mesothelioma is a type of lung cancer. But peritoneal mesothelioma accounts for about 500 of the 2,500 cases of mesothelioma in the US each year.
Peritoneal mesothelioma occurs in the lining of the abdomen. One of the most common treatments is cytoreductive surgery. This is when surgeons remove all visible signs of cancer. They usually follow that up by rinsing the abdomen with a mix of heated chemotherapy drugs.
Doctors have had good luck using paclitaxel after surgery for metastatic peritoneal mesothelioma. They deliver the drug directly into the abdomen. It goes through a catheter that stays in place. This is called intraperitoneal administration. Giving paclitaxel this way causes fewer side effects than systemic chemotherapy.
“Paclitaxel given by repeated instillation through an intraperitoneal port has demonstrable responses in ovarian cancer, peritoneal mesothelioma, gastric cancer and pancreas cancer when peritoneal metastases are present,” writes Dr. Sugarbaker.
According to Dr. Sugarbaker, its ability to prevent metastatic peritoneal mesothelioma in high risk patients “seems less well established.”
Preventing New Mesothelioma Tumors
The new article represents Dr. Sugarbaker’s study of the “pharmacokinetics and drug characteristics of paclitaxel”. He looked at how this drug is usually used and how well it works.
Studies show paclitaxel can prevent metastatic ovarian cancer tumors. But a similar study of people with gastric and pancreatic cancer was less conclusive. Dr. Sugarbaker’s research suggests that there is still reason for patients with metastatic peritoneal mesothelioma cancers to be hopeful.
“The pharmacology of intraperitoneal paclitaxel strongly suggests that intraperitoneal administration should be of benefit to prevent or treat peritoneal metastases,” he writes.
There are not yet any protocols in place for cancer doctors to follow to prevent metastatic peritoneal mesothelioma in high risk people with paclitaxel. Dr. Sugarbaker says more study into the technique is needed.
Sugarbaker, P, “Intraperitoneal paclitaxel: pharmacology, clinical results and future prospects”, April 2021, Journal of Gastrointestinal Oncology, Supplement 1, https://jgo.amegroups.com/article/view/42079/html