Intraperitoneal Chemotherapy of Malignant Peritoneal Mesothelioma Cancer

Intraperitoneal Chemotherapy

The use of intraperitoneal chemotherapy for this disease that exclusively involves the abdominal and pelvic space is slow to develop. The initial use of intraperitoneal chemotherapy for this disease is difficult to determine because it occurs as a result of Case Reports and a small series of patients. 

Initial reports of limited benefit of Intraperitoneal Chemotherapy (IP) compared to the absence of benefit from IV chemotherapy were reviewed by Averbach and Sugarbaker in 1996 (Averbach et al. 1996). 

Plus in 1988 the University of Colorado reported a 38-year-old patient who with a second operation had a documented complete pathological response (Plaus 1998). Treatment is performed with IP cisplatin and IV doxorubicin. Long-term follow-up in these patients is not available, and chemotherapy doses and schedules are not provided. Several other small series of benefits of IP chemotherapy for MPM has been published (Piccigallo et al. 1988; Vidal-Jove et al. 1991; Moore et al. 1992; Sugarbaker and Fernandez-Trigo 1996).

Three groups from the United States reported more extensive experience with this treatment modality. Treatment strategies developed by Antman and colleagues (Antman et al. 1985) and Lagerman and colleagues (Lederman et al. 1987, 1988) combined tumor debulking, intraperitoneal administration of doxorubicin and cisplatin, and whole stomach radiation. 

To reduce the incidence of chemical peri - tonite from doxorubicin, corticosteroids are used. The results of this study from the Dana-Farber Cancer Institute did result in a fairly long survival estimated at 16 months. The role of abdominal irradiation in prolonged survival is unclear, and these results were achieved in a highly selected group of patients (Markman 1993).

Another group from the University of California, San Diego, applied high-dose intraperitoneal cisplatin with systemic thiosulfate protection in an unselected group of patients with peritoneal mesothelioma (Pfeifle et al. 1985; Markman et al. 1986). An objective response was recorded in 57% of patients, including a complete response in 28.5% of patients. The median survival of all patients was 14 months with responders being 18 months.

The combination of intraperitoneal cisplatin and mitomycin C was evaluated by Markman and Kelsen (Markman and Kelsen 1989, 1992). The treatment is based on the synergy of these drugs in the experimental system and their known activity on peritoneal mesothelioma. 

The treatment was fairly well tolerated although most patients had therapy discontinued due to the failure of the catheter to maintain access to the peritoneal space. In 47% of patients, control of ascites reaccumulation was achieved for an average of 8 months. The median survival of all patients was 9 months, and 17.8 months among respondents. Twenty-one percent of patients survived 3 years and 10.5% of patients survive 5 years.

It is worth mentioning that in studies from the University of California and from Memorial Sloan Kettering Cancer Center, debulking surgery is not an essential part of the treatment protocol. Possible debulking roles are emphasized by Lederman and colleagues (Lederman et al. 1987).

Source

Harvey I. Pass, Nicholas Vogelzang, Michele Carbone - Malignant Mesothelioma_ Pathogenesis, Diagnosis, and Translational Therapies-Springer (2005)

Mary Hesdorffer, Gleneara E. Bates-Pappas - Caring for Patients with Mesothelioma_ Principles and Guidelines-Springer International Publishing (2019)

Bruce W S Robinson, A Philippe Chahinian - Mesothelioma (2002).

Cytoreductive,Surgery,for Mesothelioma,Cancer,Mesothelioma cancer,History Cancer,History Mesothelioma,peritoneum,tumor,molecular,

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