For people with diffuse malignant peritoneal mesothelioma, putting off surgery to have chemotherapy first could be a mistake.
Researchers from dozens of French hospitals found that their peritoneal mesothelioma patients who underwent neoadjuvant chemotherapy prior to CRS-HIPEC (cytoreductive surgery and heated intraperitoneal chemotherapy) had shorter survival than patients who had a different treatment approach.
Chemotherapy and Peritoneal Mesothelioma
Chemotherapy for peritoneal mesothelioma can be delivered in a variety of ways and at different times in the course of mesothelioma treatment.
Neoadjuvant chemotherapy is systemic chemotherapy that is delivered in the weeks or months prior to mesothelioma surgery. The goal is usually to help shrink the mesothelioma tumor to improve the chances of removing it thoroughly during surgery.
Intraoperative chemotherapy (HIPEC) involves rinsing the peritoneal cavity with drugs during mesothelioma surgery while the patient is still under anesthesia. The hope is that the drugs will kill any mesothelioma cells left behind by the surgeon.
Adjuvant chemotherapy has the same goal, but it is delivered systemically (by infusion) in the weeks or months after cytoreductive mesothelioma surgery.
Mesothelioma Survival After CRS-HIPEC
The CRS-HIPEC treatment combination has become the gold standard for improving peritoneal mesothelioma survival among patients who are fit enough to have surgery.
The aim of the new retrospective French study was to determine the impact of various systemic chemotherapy strategies on mesothelioma survival and outcomes after CRS-HIPEC.
The researchers evaluated the cases of 126 peritoneal mesothelioma patients who underwent CRS-HIPEC at 20 different hospitals between 1991 and 2014. All of the patients evaluated were comparable in terms of their prognostic factors.
Shorter Survival with Neoadjuvant Chemotherapy
After a median follow-up of five years, the team found that only 40 percent of the peritoneal mesothelioma patients who had delayed surgery to have neoadjuvant chemotherapy were still alive.
In contrast, 67 percent of those who had had adjuvant chemotherapy after surgery were still living. Even among mesothelioma patients who had no systemic chemotherapy at all, there was a 56 percent five year survival rate.
“The retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that neoadjuvant chemotherapy may impact negatively the survival for patients with diffuse malignant peritoneal mesothelioma who underwent CRS-HIPEC with curative intent,” writes the study’s lead author, Dr. Vahan Kepenekian with Lyon-Sud University Hospital.
The study was published in the European Journal of Cancer.
Kepenekian, V, et al, “DIffuse malignant peritoneal mesothelioma: Evaluation of systemic chemotherapy with comprehensive treatment through the RENAPE Database: Multi-Institutional Retrospective Study”, July 26, 2016, European Journal of Cancer, pp. 69-79, Epub ahead of print