Standardization Needed for Peritoneal Mesothelioma Treatment

Mesothelioma researchers in Belgium and the US have some good news and some bad news about peritoneal mesothelioma treatment.

The good news is that the combination of cytoreductive surgery to remove the mesothelioma tumor and intraperitoneal chemotherapy (HIPEC) to kill residual cancer cells improves mesothelioma survival. Overall, the method is so effective that the authors say the combination should now be considered standard of care for peritoneal surface malignancies like mesothelioma.

The bad news is that, although there are limited ways to perform surgery for peritoneal mesothelioma, there are many ways to deliver intraperitoneal chemotherapy.

According to Paul Sugarbaker, MD, of the Washington Cancer Institute in Washington, DC, and his colleagues Lieselotte Lemoine and Kurt Van der Speeten of Belgium, the lack of a universally-accepted dose, duration or even drug combination for intraperitoneal chemotherapy means the data on this treatment is incomplete, at best.

In a new article in the International Journal of Hyperthermia, they call for more study to narrow down and standardize intraperitoneal chemotherapy in order to optimize survival of malignant mesothelioma and other cancers that have metastasized to the peritoneum.

Treating Peritoneal Mesothelioma

Peritoneal mesothelioma is a rare form of the asbestos cancer that occurs on the lining around the abdominal organs. Fewer than 20 percent of mesothelioma patients have this variety, which is associated with the accidental swallowing of microscopic asbestos fibers.

Colorectal, appendiceal, gastric, and ovarian cancers can also spread to the peritoneum. In recent years, doctors have found that removing these peritoneal tumors with cytoreductive surgery and immediately rinsing the body cavity with a heated solution of chemotherapy is usually the best way to treat it.

But survival can vary widely among peritoneal mesothelioma patients who have this treatment, ranging from just a few months to many years. Now, Dr. Sugarbaker and his colleagues say part of the problem is that every doctor does it differently.

“Although there is near universal standardization regarding the cytoreductive surgery, we are still lacking a much-needed standardization amongst the various intraperitoneal chemotherapy treatment modalities used today in clinical practice,” states the report summary.

Too Many Approaches to HIPEC

Right now, a mesothelioma patient undergoing CRS and HIPEC may have one of a several different combinations of drugs such as pemetrexed (Alimta), cisplatin, carboplatin, gemcitabine, methotrexate, or vinorelbine.

These drugs may be used in different concentrations, heated to different temperatures, and rinsed through the abdomen for different lengths of time.

Dr. Sugarbaker and his colleagues say this “myriad of variables” raises many questions about the role of HIPEC in mesothelioma treatment. They suggest that these questions be answered by generating more pharmacologic evidence on exactly what works and why.

Source:

Lemoine, L, et al, “Drugs, doses, and durations of intraperitoneal chemotherapy: standardizing HIPEC and EPIC for colorectal, appendiceal, gastric, ovarian peritoneal surface malignancies and peritoneal mesothelioma”, Volume 33, 2017, International Journal of Hyperthermia