Novel Technique Controls Pleural Effusion in Mesothelioma Patients

Japanese researchers have come up with a new method of controlling one of the most bothersome and life-limiting symptoms of late stage malignant mesothelioma – a buildup of fluid around the lungs called malignant pleural effusion.

When fluid collects in the space between the layers of the pleural membrane around the lungs, it becomes more difficult for the lungs to expand properly. At this stage, many patients with advanced mesothelioma experience shortness of breath, chest pain, and fatigue.

Pleural effusion is a common side effect in the later stages of several other cancers including lung cancer, breast cancer and ovarian cancer. In addition to being uncomfortable, recent research has suggested that the fluid, which contains malignant cells, may also help to spawn new mesothelioma tumors.

Treating Pleural Effusion in Mesothelioma Patients

Pleural effusion can be temporarily treated by draining off the fluid as it collects through a procedure called a thoracostomy. Another method called pleurodesis uses a chemical or a surgical procedure to eliminate the pleural space where fluid collects.

But now researchers at Saitama Medical University in Saitama, Japan have developed what they say is a viable alternative for treating malignant pleural effusions in people with malignant mesothelioma and other cancers.

The procedure, called intrapleural perfusion with hyperthermic chemotherapy (IPHC) involves circulating or “perfusing” the pleural space with a heated solution in an effort to stop the production of malignant pleural effusions.

The Japanese team used a saline solution containing 80 mg/m2 of the platinum-based drug cisplatin, one of the primary drugs used in systemic chemotherapy for  mesothelioma.

Treating Pleural Effusions with Fewer Side Effects

In twenty-one patients with pleural effusions, including 8 with lung cancer, 7 with mesothelioma, and 5 with other types of cancer, the pleural space was perfused with the cisplatin-containing solution for an hour at a temperature of 43 °C. Afterward, the research team measured how well the body absorbed the cisplatin and what impact it had on the pleural effusions.

“Area under curve (AUC) of free platinum in the pleural space was calculated to be 26.3μg/mLxh, resulting in complete control of pleural effusion for 3 months after IHPC in all cases,” writes the study’s primary author, Dr. Hirozo Sakaguchi in the journal Lung Cancer.

The team discovered that the amount of platinum in the pleural space, where malignant mesothelioma grows and where malignant pleural effusions are produced, was much higher than the levels typically seen in patients who receive cisplatin the traditional way (intravenously).

Just as importantly, because less of the drug ended up in the blood serum of mesothelioma patients, the new method tended to produce fewer serious side effects; six patients experienced low-grade liver toxicity while seven had mild vomiting.

The report concludes that IPHC with cisplatin is a viable optional treatment for controlling malignant pleural effusion.

An estimated 2,500 Americans are diagnosed with malignant mesothelioma each year, despite government regulations aimed at limiting asbestos exposure. More than 90 percent of these patients will experience malignant pleural effusions.

Source:

Sakaguchi, H, et al, “Pharmacokinetic evaluation of intrapleural perfusion with hyperthermic chemotherapy using cisplatin in patients with malignant pleural effusion”, February 2017, Lung Cancer, pp. 70 – 74