New Chemotherapy Technique Carries Risks for Peritoneal Mesothelioma Patients

A new way of delivering chemotherapy drugs to the site of a peritoneal mesothelioma tumor has some unique benefits, but can also be risky.

The technique, called pressurized intraperitoneal aerosol chemotherapy (PIPAC) allows doctors to “spray” a solution of chemotherapy drugs directly onto peritoneal tumors through small ports in the abdomen.

The intention is to uniformly coat the tumor and help keep chemotherapy drugs in contact with malignant mesothelioma or other peritoneal cancer cells for as long as possible.

Testing PIPAC for Unresectable Mesothelioma

The PIPAC technique is being pioneered in Europe. In a new French study, doctors tested it in 73 patients who had peritoneal mesothelioma or metastatic colorectal, gastric, or ovarian cancer on the peritoneal membrane lining the abdomen. To be included in the study, patients had to have tumors that could not be removed surgically.

All together, the study subjects underwent a total of 164 PIPAC procedures. All of the patients had more than one PIPAC treatment and one patient had a total of six.

Good and Bad News for Mesothelioma Patients

The peritoneal cancer index (PCI), a measure of the extent of a patient’s peritoneal cancer, improved in 64.5% of patients. For 63.5% of patients, their peritoneal cancer symptoms, including pain, bloating, diarrhea and constipation, completely cleared up after PIPAC.

But there was a downside to PIPAC treatment for patients with malignant mesothelioma and other peritoneal cancers; almost 10% of patients experienced major complications and 5 patients died within 30 days.

Physician Experience Lowers Risk

In the first 20 patients treated, the mortality rate from PIPAC was 40% and the rate of complications was 62%. Both rates gradually improved as doctors became more adept at the procedure. Eighty-eight percent of patients were able to undergo systemic chemotherapy within a few weeks after PIPAC to improve their cancer control.

The researchers conclude that, while it is “feasible” to deliver PIPAC along with systemic chemotherapy, it also poses significant risks for mesothelioma patients and others with peritoneal cancer.

“Implementing a PIPAC program in association with systemic chemotherapy is…associated with a risk of postoperative morbidity, even in teams highly experienced in PC management and requires a learning curve in patient selection,” concludes lead author Mohammad Aliyami, MD, with Centre Hospitalier Lyon-Sud.

The report appears in a recent issue of the European Journal of Surgical Oncology.

Source:

Aliyami, M, “Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis”, September 21, 2017, European Journal of Surgical Oncology, Epub ahead of print