Benefits of Spray Chemotherapy for Peritoneal Mesothelioma Patients Tested in Clinical Trial

Ongoing mesothelioma research is critical for finding new, effective ways to treat the insidious cancer. Chemotherapy via an IV is the most commonly prescribed modality for the treatment of mesothelioma, however, it requires many rounds and is not always effective. Now, researchers report that a new aerosol form of chemotherapy administered directly to the tumors may be more effective.

PIPAC, or pressurized intraPeritoneal aerosol chemotherapy, is a new technique that allows a doctor to inject chemotherapy via a nebulizer during a laparoscopy, a procedure where a fiber-optic instrument is inserted through the abdominal wall, that then forms an aerosol landing on the cancerous cells. Not yet available in the U.S., researchers from Germany report that in a study where PIPAC was administered to peritoneal mesothelioma patients they saw a “significant histological regression of malignant mesothelioma in the majority of patients,” according to the April 18 study in BMC Cancer.

https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-4363-0

Both peritoneal and pleural mesothelioma are rare, incurable cancers caused by exposure to airborne asbestos fibers. Peritoneal mesothelioma is a form of the cancer that affects the lining of the abdomen. While there are close to 3,000 cases of mesothelioma diagnosed in the United States each year, less than 10% of those are peritoneal. Pleural mesothelioma is found in the outer lining of the lungs.

In the U.S., researchers focus on hyperthermic intraperitoneal chemotherapy (HIPEC) and hyperthermic intraoperative chemoperfusion (HIOC) techniques where mesothelioma tumors are bathed in hot chemotherapy, often at the end of surgery conducted to remove the tumors. HIPEC is used in peritoneal mesothelioma, whereas HIOC is used in pleural mesothelioma patients.

In the study of 29 “extensively pre-treated patients,” including prior abdominal surgery and  chemotherapy, who received at least two PIPAC applications, over half had tumor shrinkage, with 20% seeing “major and even complete tumor response.” In addition, many patients reported “general improvement” in their quality of life as well as relief in often debilitating symptoms such as appetite loss, constipation, and nausea.

Although the results were considered “promising,” the researchers cautioned that “it remains unclear whether this effect is attributed to PIPAC or to selection bias.”

Chemotherapy is the most common treatment for mesothelioma patients, whether as a single mode or multi-mode treatment with surgery and/or radiation. Most people who are diagnosed with the disease in its later stages are not eligible for “curative” surgeries, so chemotherapy becomes their best chance at extending life. Researchers report that with the PIPAC delivery method higher concentrations of the  drugs are delivered directly to the cancerous cells throughout the abdomen.

Find out more about the clinical trial for mesothelioma on ClinicalTrials.gov.

https://clinicaltrials.gov/ct2/show/NCT03172416

Read about the study in the April 18 issue of BMC Cancer.

https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-4363-0