Refining CRS-HIPEC for Peritoneal Mesothelioma

Three new international studies are helping to refine a treatment for peritoneal mesothelioma that involves rinsing the body cavity with heated chemotherapy drugs.

The treatment, called heated intraperitoneal chemotherapy or HIPEC, begins with surgery to remove as much of the mesothelioma tumor as possible from the surface of the peritoneal membrane. Chemotherapy drugs are then heated and rinsed through the area while the patient is still in surgery. The goal is to destroy any residual cancer cells and keep mesothelioma from growing back.

Although the treatment is still relatively new, it is quickly becoming the standard of care for peritoneal mesothelioma. Now, researchers around the world are working on ways to make HIPEC even more effective.

In one new study, Canadian researchers reported their eight-year experience performing HIPEC with the chemotherapy drug oxaliplatin. Patients with epithelial or multicystic peritoneal mesothelioma were treated with cytoreductive surgery and heated oxaliplatin at for 30 minutes.

All of the peritoneal mesothelioma patients treated this way between 2004 and 2012 at the University of Montreal lived for at least a year and 91 percent lived for three years. Half of the patients were mesothelioma free for three years. None of them died from the treatment. The research team concluded that HIPEC-OX is a “valid treatment” for peritoneal mesothelioma.

In a separate Italian study, researchers followed surgery with a 60 minute rinse with a chemotherapy drug called cisplatin. The mean survival among the six mesothelioma patients and two lung cancer patients in that study was 13.6 months. Just as importantly, no one died or even experienced any major complications from the treatment.

Finally, a third study conducted in Singapore followed 7 patients with various types of peritoneal-based malignancies (including mesothelioma) who underwent more than one round of cytoreductive surgery and HIPEC. One experienced some complications, but the rest lived for at least a year after their last treatment without complications. The authors conclude that repeated CRS/HIPEC is safe and can “achieve prolonged survival” in select patients.

Sources:

Wong, JF et al, “Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis”, February 5, 2015, World Journal of Surgery

Migliore, M et al, “Cytoreductive surgery and hyperthermic intrapleural chemotherapy for malignant pleural diseases: Preliminary experience”, January 2015, Future Oncology

Hubert, J et al, “Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with oxaliplatin for peritoneal mesothelioma: Preliminary results and survival analysis”, January 8, 2015, Surgical Oncology