German surgeons are reporting on a potential new way to improve outcomes for people with malignant pleural mesothelioma by infusing chemotherapy drugs in an isolated area and then removing them.
In an article in OncoTargets and Therapy, surgical oncologists from Burghausen, Germany say they were prompted to test the new technique after radical mesothelioma surgery “failed to translate into a definite survival advantage.”
Mesothelioma Treatment Risks
Although malignant mesothelioma, an asbestos-linked cancer that grows on the mesothelial membrane, is extremely rare, it is also one of the most difficult cancers to treat. Most patients diagnosed with this rare malignancy die of their illness in less than a year.
Patients who are otherwise healthy may be recommended for surgery but mesothelioma surgery carries many risks. The most radical type, which involves the removal of a lung, carries the most risk. Chemotherapy carries a different set of risks and is typically only moderately effective in pleural mesothelioma because of dose-limiting side effects.
Isolating Chemotherapy Drugs
But the German team says infusing chemotherapy drugs in a specific isolated area – and preventing them from circulating throughout the body – may improve the odds of surviving mesothelioma with fewer risks than surgery or systemic chemotherapy.
Their study included 28 patients with advanced pleural mesothelioma. Their technique involved creating an isolated circuit for chemotherapy in the chest by inserting stop-flow balloon catheters in strategic locations.
“The aorta and inferior vena cava were blocked at the level of the diaphragm and the upper arms were blocked by pneumatic cuffs,” explains chief investigator Karl Reinhard Aiger.
With the rest of the body thus protected from the damaging effects of chemotherapy, a mixture containing cisplatin and mitoxantrone was then administered directly into the aorta. The chemotherapy drugs were allowed to circulate in the area of the mesothelioma tumor for 15 minutes, after which a machine was used to filter the drugs out of the blood.
The technique is called isolated thoracic perfusion with chemofiltration (ITP-F).
Although evaluation of the new technique is ongoing, the early results of the Phase II study appear to be promising.
All of the mesothelioma patients in the study saw some positive results from the treatment and, thanks to the chemofiltration, the toxicity of the drugs was limited. None of the patients developed life-threatening side effects and nearly half were still alive one year after treatment. Just under a third of the mesothelioma patients survived for two years and 18 percent were still alive at five years.
The report concludes, “ITP-F for patients with advanced pleural mesothelioma, progressive after standard therapies, is an effective and well-tolerated treatment modality, offering comparably long survival data at a good quality of life.”
Aigner, KR, et al, “Isolated thoracic perfusion with chemofiltration for progressive malignant pleural mesothelioma”, June 19, 2017, OncoTargets and Therapy, eCollection 2017