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“Spray On” Drugs May Be New Option for Peritoneal Mesothelioma Patients

ByAlex Strauss

Surgery for Peritoneal Mesothelioma

A new, minimally-invasive way of delivering drugs right to the site of a tumor is being called “safe and feasible” for people with recurrent malignant mesothelioma.

Right now, mesothelioma patients whose cancer comes back after surgery and systemic chemotherapy have few viable treatment options.

The new procedure, called Pressurized Inraperitoneal Aerosol Chemotherapy (PIPAC), may change that. During PIPAC, chemotherapy drugs are essentially “sprayed” as gas directly onto the site of the cancer. PIPAC is performed through a small incision using a laparoscope for guidance.

Testing PIPAC in Mesothelioma Treatment

Right now, PIPAC is still in clinical trials, but it has already been used on thousands of patients in Germany and several other European locations.

In a new malignant mesothelioma study, French and German researchers reviewed the cases of 29 patients with recurrent malignant mesothelioma.  

 

Patients received an average of 2.5 treatments each with PIPAC (or a similar procedure for the chest cavity called PITAC) with a mixture of the drugs doxorubicin and cisplatin. PIPAC/PITAC treatments are typically delivered about six weeks apart.

Specifically, the researchers were looking to see if there was any regression in these patients’ mesothelioma tumors, whether there were any serious side effects from the treatments, and what kind of impact these procedures had on mesothelioma survival.

PIPAC Mesothelioma Study Results

To measure the response of the mesothelioma tumors to PIPAC or PITAC, the researchers used a tumor regression grade (TRG) scale.

In the 20 patients who had more than two PIPAC/PITAC procedures, 15 of them (75%) experienced some amount of regression of their mesothelioma tumors. In 20 percent of these patients, that regression was major and in 10 percent, it was described as “complete regression”.

In other words, PIPAC stopped these mesothelioma tumors in their tracks.

Just as importantly, only two of the mesothelioma patients experienced serious (grade 4) complications and these were only observed in patients who had also undergone cytoreductive surgery.

“After a follow-up of 14.4 months after the last PIPAC/PITAC application, median overall survival was 26.6 months (from the first application),” the researchers report in BMC Cancer.  

The team concludes that PIPAC “induces significant histological regression of malignant mesothelioma in the majority of peritoneal patients.” Although PITAC for pleural mesothelioma is deemed to be feasible, researchers say the jury is still out on its safety and efficacy in controlling malignant pleural effusions.

Potential Advantages of PIPAC for Malignant Mesothelioma Patients

A number of previous studies have shown that PIPAC may have several advantages over other types of chemotherapy delivery methods for people with malignant mesothelioma and other types of cancer.

Here are a few potential advantages of PIPAC

  • PIPAC is minimally invasive, reducing the risks associated with open surgery
  • PIPAC can be repeated up to 8 times in a single patient, to keep tumors from coming back
  • Aerosolized chemotherapy drugs may be absorbed into tissues better than liquid
  • Precise delivery minimizes the side effects associated with systemic or more widely-delivered chemotherapy
  • Can be used in mesothelioma patients who may not be candidates for cytoreductive surgery and heated intraperitoneal chemotherapy

PIPAC was developed in Germany by Dr. Marc Reymond, now DIrector of the PIPAC Program at University Hospital in Tübingen, Germany.

Sources:

Giger-Pabst, U, et al, “Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for the treatment of malignant mesothelioma”, April 18, 2018, BMC Cancer

Nowacki, M, et al, “Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study”, February 22, 2018, European Journal of Surgical Oncology, Epub ahead of print

“Peritoneal mets. New, local treatment: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy”, Colon Talk, December 12, 2016

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