New research suggests that patients with peritoneal mesothelioma would benefit from multiple rounds of chemotherapy. Findings show a newer treatment protocol produces a 5-year overall survival rate in 75% of patients.
Peritoneal mesothelioma is a rare form of cancer that forms in the lining of the abdominal wall. The current standard of care is cytoreduction with HIPEC, a procedure that combines surgery and hyperthermic perioperative chemotherapy.
Originally pioneered by Dr. Surgarbaker, cytoreduction with HIPEC produces a relatively high survival rate compared to treatments for other types of mesothelioma.
Despite the good results, Dr. Sugarbaker and his colleague, Dr. David Chang, began researching ways to improve upon the success of cytoreduction with HIPEC in an effort to produce even higher survival rates among patients.
Current Standard Peritoneal Treatment Has Median 5-Year Survival
In the past patients diagnosed with peritoneal mesothelioma had a very low chance of long-term survival. However, as treatments changed over the past two decades, so has the survival rate.
For example, by making cytoreduction with HIPEC the standard treatment, the five-year survival rate among patients jumped to 44%.
The next change was when doctors started giving the patients additional rounds of chemotherapy in the days following their surgery. This was known as early postoperative intraperitoneal chemotherapy (EPIC). Doing this increased the five-year survival rate to 52%.
With these promising results, Drs. Sugarbaker and Chang set out to discover whether doctors should keep giving their patients chemotherapy after surgery, HIPEC, and EPIC are finished to further improve survival.
Multiple Chemotherapy Rinses
The newly devised approach to peritoneal mesothelioma treatment involves administering additional rinses of chemotherapy into the abdomen through a catheter — a procedure called normothermic intraperitoneal chemotherapy (NIPEC).
Some of the key differences between NIPEC and HIPEC are:
- NIPEC does not happen during the surgery
- NIPEC is not heated
- The specific combination of chemotherapy drugs are different
While the use of NIPEC is still new, the early results are promising. When patients received chemotherapy rinses on top of cytoreduction with HIPEC, their five-year survival rate jumped to 75%.
New Therapy May Not Be Suitable for Every Patient
While the results of the NIPEC approach are incredible, the treatment plan may not be a good fit for every patient. Doctors need to determine who is eligible for multiple rounds of chemotherapy by putting patients through a selection process.
Doctors decide eligibility by looking at:
- Location of cancer tumors
- Size of tumors
- The patient’s overall health
The operation and chemotherapy bath can last up to 12 hours, so the patient needs to be healthy enough to survive the procedure.
Doctors are also interested in cell type —whether a patient has epithelioid, sarcomatoid, or biphasic (mixed) mesothelioma. According to the research, patients with epithelioid cell type will have a better outcome from this procedure.
Getting Support for Mesothelioma Therapy
Peritoneal mesothelioma is a complex disease that is difficult to fight. Patients need access to the latest therapies and research as part of their treatment plan to extend survival. It is important for peritoneal mesothelioma patients to work with mesothelioma specialists who can administer emerging therapies like NIPEC.