Laparoscopic Cytoreductive Surgery Followed by HIPEC Offers Patients with Peritoneal Mesothelioma Shorter Recovery Time with Fewer Complications

The standard treatment for peritoneal mesothelioma patients eligible for surgery is cytoreductive surgery (CRS) followed immediately by heated intraperitoneal chemotherapy (HIPEC). 

Traditional surgery involves a large incision made in the abdomen in order to remove as much cancer as possible. A study published in the European Journal of Surgical Oncology shows that patients suffering from peritoneal surface malignancy from mesothelioma and other cancers may benefit from less invasive laparoscopic surgical procedures. Laparoscopic procedures require a much smaller incision than traditional surgery and utilize a fiber optic camera so that surgeons may perform the procedure viewing a monitor.

Researchers at the Hospices Civils de Lyon in France compared two groups of patients who underwent CRS followed by HIPEC. Patients in the first group underwent the laparoscopic CRS procedure and experienced far fewer complications and spent an average of a week less in the hospital than those in the second group who underwent the more traditional CRS procedures. Another benefit of the laparoscopic approach is reduced pain due to smaller incision and less hemorrhaging. All participants in the study were diagnosed with early stage disease which had not spread beyond the peritoneum.

Fewer complications, shorter recovery time and reduced pain all contribute to better quality of life, which is of great value to any cancer or surgical patient. Many hospitals and surgical centers now offer the minimally invasive laparoscopic procedure for a wide range of ailments. Peritoneal mesothelioma patients should speak to their surgeon to find out if laparoscopic surgery is an option for them.

Thermal Therapy in the Treatment of Malignant Pleural Mesothelioma

As presented by Dr. Robert Cameron at the 11^th International Conference of the International Mesothelioma Interest Group (iMig)  

Boston, MA – September 11-14, 2012

Thermal therapy has been used in cancer therapy for decades and hyperthermic chemotherapy perfusion, specifically, has been used in the treatment of mesothelioma but without data as to the optimal conditions.

In a study performed at UCLA, doctors sought to define in vitro the most effective strategy for the use of thermal therapy in pleural mesothelioma. They exposed three human mesothelioma cell lines to varying hyper and hyperthermic conditions using either a standard metabolic MTS absorbance assay or a standard clonogenic (which is a microbiology technique for studying the effectiveness of specific agents on the survival and proliferation of cells). Each cell line was then expanded and exposed to varying combination of hyperthermia, hypothermia and/or chemotherapy – using chemotherapy agents cisplatin, gemicitabine, and/or pemetrexed.

Their findings show that thermal therapy appears to be most effective when using hypothermia rather than hyperthermia, and chemotherapy appears to be most effective when using two drug combinations over one individually. Click here to view this abstract. 

Study Involving New Chemotherapy Combination Shows Improved Results Over Cisplatin for Pleural Mesothelioma

To date, chemotherapy drugs used to treat mesothelioma have primarily included cisplatin, onconase, carboplatin, gemcitabine, navelbine and pemetrexed (Alimta). In some cases, these medications have been noted to stall the progression of mesothelioma tumors. Chemotherapy, however, has been shown to be most effective when combined with surgery, radiation, or other treatment modalities, known as multi-modal treatment.

Since 2004, the only chemotherapy regimen which the FDA has approved for pleural mesothelioma is cisplatin and Alimta. The approval, however, is limited to patients who are not surgical candidates.

A recent European study has monitored the results of cisplatin used in combination with a drug called Tomudex (raltitrexed) for pleural mesothelioma. The study has shown improved median survival rates for patients on the cisplatin-Tomudex combination as compared to cisplatin alone.

Tomudex is an injectable cytotoxic medication used to treat different forms of cancer. The medication belongs to a group of cancer-fighting drugs called antineoplastics. Tomudex combats cancer by preventing cancer cell growth, which in time leads to their elimination.

In the study, one group was treated with cisplatin alone and another group was treated with both cisplatin and Tomudex. The overall response rate for the cisplatin-Tomudex group was higher than the cisplatin group, 23.6 percent and 13.6 percent, respectively. Tomudex was shown to improve median overall survival by 2.8 months and Tomudex was associated with improved progression-free survival.

Professor J.P. van Meerbeeck (professor of Thoracic Oncology at Ghent University, Belgium) said, “Malignant pleural mesothelioma is a hard to treat, rare cancer with a poor prognosis. New treatment options such as a combination of cisplatin and raltitrexed, which improve patient outcomes with no detrimental effect on quality of life as compared to cisplatin alone are a welcome addition to our therapeutic portfolio.”

Tomudex is currently licensed for the treatment of pleural mesothelioma in Portugal, Czech Republic and Hungary. Additional licensing is expected across Europe in late 2010.

Please check back with Mesothelioma Bytes for future updates on the testing and approval of Tomudex in the treatment of mesothelioma.