Unresectable Peritoneal Mesothelioma Becomes Operable After Bi-Directional Chemotherapy

French researchers have successfully operated on a man with unresectable peritoneal mesothelioma after treating him with bi-directional chemotherapy.

Chemotherapy is the most common treatment for unresectable peritoneal mesothelioma. Most mesothelioma patients have chemotherapy by IV infusion.

But some cancer centers now offer another chemotherapy delivery method. Intraperitoneal chemotherapy bypasses the bloodstream. It lets doctors put higher doses of cancer-killing medicine at the site of a tumor.

The French team combined the two types of chemotherapy in one patient. It shrunk the patient’s unresectable peritoneal mesothelioma tumor enough to perform surgery. 

Two Types of Mesothelioma Chemotherapy

With IV chemotherapy, medicine travels to the tumor through the bloodstream. It is one way of treating unresectable peritoneal mesothelioma.

One drawback of IV chemotherapy is that healthy tissue can also absorb the medicine. If healthy cells absorbs too much, the patient can have serious side effects. Doctors have to limit the dose when they use IV chemotherapy.

Intraperitoneal chemotherapy is a newer method for treating mesothelioma. Usually, it happens during surgery (CRS), right after the tumor is removed. It puts the medicine right where the tumor is. This method allows doctors to use higher doses.

When surgery and intraperitoneal chemotherapy happens at the same time, it is called CRS with HIPEC.

CRS with HIPEC is becoming the preferred method for treating peritoneal mesothelioma patients who can have surgery.

Bi-Directional Chemotherapy for Unresectable Peritoneal Mesothelioma

In the French case, the 55-year-old patient was not initially a candidate for CRS with HIPEC. His tumor was too large and widespread in his abdomen for surgery.

So his doctors tried a bi-directional chemotherapy approach to shrink it. They started with standard IV chemotherapy.

Then they applied medicine directly to the tumor using a new spray-on method. The method is called PIPAC. PIPAC and infusion reduced the size of the man’s unresectable peritoneal mesothelioma tumor. 

“CT scan and laparoscopy showed a macroscopic [visible] response,” writes researcher Barbara Noiret. “The peritoneal disease was thinner allowing a complete CRS with…HIPEC.”

The team says other patients with unresectable peritoneal mesothelioma could benefit from this two-pronged approach.

“BDC (IV and IP) has promising results and allows…surgery for selected patients with borderline or initially unresectable MPM,” writes Noiret.

Source:

Noiret, B and Eveno, C, “Bidirectional chemotherapy allowing surgery and HIPEC for malignant peritoneal mesothelioma”,  June 21, 2019, Pleura and Peritoneum, https://doi.org/10.1515/pp-2019-0011