Intracavitary therapies for mesothelioma

Our plain-English summary of Intracavitary therapies for mesothelioma, by C.F. Verschraegen (Current Treatment Options in Oncology, 2001).

The study

• Author: C.F. Verschraegen
• Journal: Current Treatment Options in Oncology
• Published: 2001;2(5):385-94
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The diagnosis of mesothelioma needs to be defined histologically. The staging system has been recently redefined anatomically, but may not be applicable to extrapleural mesothelioma. Further clinicopathologic studies need to be performed to molecularly classify the disease further, according to prognosis. Intracavitary therapy has a definite role in the treatment of mesothelioma. Randomized studies of intracavitary therapies are needed to define the best treatment option. The role of complementary therapeutic modalities such as surgery and radiotherapy needs to be defined by randomized studies. There is an urgent need to better understand the biology of mesothelioma, which may lead to more focus on molecularly relevant therapies.

In plain English

This article was a review and opinion piece on intracavitary therapies for mesothelioma, meaning treatments delivered directly into the abdominal (peritoneal) or chest (pleural) cavity. It did not study asbestos exposure, though it noted asbestos is the main risk factor. The author described published studies of drugs given into these cavities, and also covered immunotherapy, radioactive colloids and surgery. In one study described, objective clinical evidence of effect with cisplatin was seen in 12% of intrapleural infusions (nine patients) and 69% of intraperitoneal infusions (13 patients), but the author noted that the intrapleural patients had more advanced disease. In another, ascites was controlled in 47% of 19 patients with malignant peritoneal mesothelioma given cisplatin and mitomycin, for a median of 8 months. In the author's group's retrospective review of 10 patients with peritoneal mesothelioma given cisplatin and irinotecan, 70% improved. The author cautioned that the published data come from heterogeneous patients, and concluded that cisplatin-based intracavitary chemotherapy seemed to be the best treatment at present and that randomized studies are urgently needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review and opinion article on intracavitary (intraperitoneal and intrapleural) treatments for mesothelioma; not an original study
• Who was studied: Published studies and case reports of patients with mesothelioma treated by intracavitary therapy, mostly peritoneal mesothelioma; the author notes the literature is larger for intraperitoneal than intrapleural therapy
• Exposure: Asbestos exposure was not studied. The article reviews treatments: intracavitary chemotherapy (cisplatin alone and with Ara-C, mitomycin C, etoposide, irinotecan and other drugs; liposomal NDDP; suramin; mitoxantrone), immunotherapy, radioactive colloids (32P) and cytoreductive surgery. As background it states asbestos is the main risk factor.
• Main results:
  • In a cited study of intracavitary cisplatin, objective clinical evidence of effect was seen in 12% of intrapleural infusions (nine patients) and 69% of intraperitoneal infusions (13 patients). The intrapleural patients had more advanced disease than the intraperitoneal patients.
  • In a cited study of 19 patients with malignant peritoneal mesothelioma given intraperitoneal cisplatin and mitomycin, ascites was controlled in 47% of patients for a median of 8 months
  • In the author's group's retrospective review of 10 patients with peritoneal mesothelioma given cisplatin plus irinotecan (CPT-11), 70% improved on treatment
  • In a cited retrospective series of patients with peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal cisplatin and doxorubicin, median survival was 31.0 months, with a 33% morbidity rate and 3% mortality rate
  • In a cited study of pleural mesothelioma, the same surgery-plus-chemotherapy approach had one death among 13 patients. Seven patients who had pleurectomy followed by radiotherapy without chemotherapy had fewer side effects and significantly longer median survival and time-to-progression.
  • For intrapleural interferon gamma in a cited report, 45% of patients with stage 1 disease experienced a remission
• The authors' conclusion: The author concluded that intracavitary therapy has a definite role in mesothelioma. Cisplatin-based intracavitary chemotherapy seemed to be the best treatment at present, and randomized studies of available treatments are urgently needed.
• Limitations the authors state:
  • The author states that the published data should be viewed with caution because the patients studied were heterogeneous
  • The author states it is not known whether surgical debulking gives a survival advantage, because no randomized studies have addressed it
  • In the cited cisplatin study, the author notes that patients treated intrapleurally had more advanced disease than those treated intraperitoneally

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Staging, Prognosis.

Related studies

• Therapeutic strategies for well-differentiated papillary mesothelioma of the peritoneum — Y.K. Lee, H.J. Jun, et al. (2013)
• Unusually favorable outcome of 6 consecutive patients with diffuse malignant peritoneal mesothelioma treated with repeated doses of intraperitoneal paclitaxel. A case series — P.H. Sugarbaker, O.A. Stuart (2020)
• Local treatment of malignant pleural mesothelioma with intracavitary cytosine-arabinoside and cisplatin — E. Aitini, E. Pasquini, et al. (1992)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Intraperitoneal therapy for peritoneal tumors: biophysics and clinical evidence — W.P. Ceelen, M.F. Flessner (2010)
• Splicing molecular biology and novel therapies in diffuse malignant peritoneal mesothelioma — A. Napolitano (2019)

Browse more research in Current Treatment Options in Oncology, or return to medical research.