Peritoneal Mesothelioma: Multi-Drug HIPEC Combo Leads to Better Outcomes

A new French study suggests that peritoneal mesothelioma patients who undergo CRS/HIPEC treatment  have better outcomes when two chemotherapeutic agents are used instead of just one.

The introduction of cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) has dramatically improved the prognosis for patients with peritoneal mesothelioma, a rare form of the asbestos cancer that occurs in the abdomen.

But a team of researchers from cancer hospitals across France wanted to know if outcomes are better with some HIPEC drugs than they are with others. Their results seem to show a clear mesothelioma survival advantage to platinum-based regimens (those including cisplatin) that include at least one other agent.

Treating a Rare Type of Mesothelioma

During CRS, surgeons remove as much of the mesothelioma tumor as possible. HIPEC is then used to kill any residual mesothelioma cells by rinsing a heated solution of chemotherapy drugs through the abdomen.

In their new CRS/HIPEC study, the French research team, led by Brice Malgras with the University of Paris, identified five different drugs that are typically used for HIPEC: cisplatin, doxorubicin, mitomycin-C, oxaliplatin, and irinotecan.

They focused on the cases of 249 peritoneal mesothelioma patients who were treated with CRS/HIPEC between 1989 and 2014. All were 80 years old or younger and all had a reasonably good performance status (a measure of overall health and activity).

Although there was no significant statistical difference in mesothelioma survival overall, survival was better among patients who were treated with two drugs rather than just one.

“This large study seems to show improved overall survival when combined chemotherapeutic agents, especially with platinum-based regimens, are used for HIPEC in patients with peritoneal mesothelioma,” the researchers write in the Annals of Surgical Oncology.  

The association between survival and HIPEC drug combination was seen among patients who underwent complete cytoreduction (meaning the surgeon was able to remove all of the visible tumor) and who had the epithelioid mesothelioma subtype.

The team goes on to suggest that, in order to be clinically useful, these findings need to be confirmed in a randomized controlled trial.

CRS/HIPEC Continues to Improve

As the French team works on refining the HIPEC portion of this mesothelioma procedure, researchers in Spain are looking at ways to make the CRS portion less invasive.

Earlier this year, doctors at the University Hospital Reina Sofia in Cordoba, Spain announced that they had successfully performed this extensive multi-part procedure through tiny incisions using an internal camera for guidance. CRS for peritoneal mesothelioma typically requires a long abdominal midline incision.

Mesothelioma patients treated with the minimally invasive approach had no significant complications and none had relapsed at 9.5 months post-surgery.

Peritoneal mesothelioma accounts for about a fifth of all mesothelioma cases.

Sources:

Malgras, B, et al, “Impact of Combination Chemotherapy in Peritoneal Mesothelioma Hyperthermic Intraperitoneal Chemotherapy (HIPEC): The RENAPE Study”, July 5, 2018, Annals of Surgical Oncology, Epub ahead of print

Arjona-Sanchez, A, et al, “Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience”, April 24, 2018, World Journal of Surgery, Epub ahead of print

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