A team of surgeons in Nebraska have determined what they say is the best chemotherapy drug to pair with surgery in patients with peritoneal mesothelioma.
Peritoneal mesothelioma is a rare form of the asbestos cancer that affects the lining of the abdomen. A treatment approach that involves removing as much of the cancer as possible with cytoreductive surgery (CRS) and then rinsing the abdomen with heated chemotherapy drugs (HIPEC) seems to produce better outcomes than systemic chemotherapy. But there is debate over the best drug to use in CRS/HIPEC treatment.
Surgeons at Creighton University Medical Center in Omaha conducted a retrospective study of peritoneal mesothelioma patients that spanned from 2003 to 2010. A total of 44 patients were treated with CRS/HIPEC at Creighton during those 7 years. Some were treated with an anti-tumor antibiotic called mitomycin while others were treated with a platinum-based drug called carboplatin.
Among the HIPEC recipients treated with mitomycin, 72 percent were still alive a year after surgery and 27 percent survived five years or longer. In contrast, almost 90 percent of the peritoneal mesothelioma patients treated with carboplatin lived for at least a year and 62.5 percent were still alive at five years.
Although there were no post-operative deaths among either group, the mesothelioma patients treated with mitomycin needed more than four times as many blood transfusions as the carboplatin group. They also spent nearly four times longer in intensive care and a median of six days longer in the hospital.
Study author Shreya Shetty, MBBS, and colleagues conclude, “HIPEC with carboplatin in diffuse malignant peritoneal mesothelioma is associated with improved overall survival and shorter hospital stay compared with HIPEC with mitomycin.” Dr. Shetty is the primary author on the report recently published in The American Surgeon.
Peritoneal mesothelioma is less common than pleural mesothelioma, accounting for about 500 cases of the annual 2,500 mesothelioma cases seen annually in the U.S. Both peritoneal and pleural mesothelioma, as well as the even rarer pericardial mesothelioma which attacks the lining around the heart, are caused by inhalation or ingestion of asbestos dust.
Source: Shetty, SJ et al, “Comparison of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with mitomycin or carboplatin for diffuse malignant peritoneal mesothelioma”, April 2014, The American Surgeon, pp. 348-352