Clapper, Patti, Schweizer and Mason

Researchers from the Washington Cancer Institute and the Thoracic Oncology Center of the MedStar Washington Hospital Center recently added more evidence to support the argument for localized chemotherapy when fighting specific cancers such as pleural mesothelioma.  The scientists monitored the intrapleural and plasma levels of mitomycin C and doxorubicin to determine the post-procedural behavior of these chemotherapy drugs in various patients. 

The study revealed, not unexpectedly, that the intrapleural levels of these locally administered chemotherapy drugs was much higher than levels found within the blood stream of individual patients.  This evidence supports the use of such drugs as localized treatments for thoracic cancers such as pleural mesothelioma because it can drastically reduce the negative side effects associated with the toxic chemotherapy drugs. 

When these drugs are delivered within the pleural cavity, either through “open” surgical procedures or during “closed” procedures requiring catheterization or insertion of a chemo “port,"  the drugs have a tendency to stay where they are needed rather than travel throughout the body.  This not only limits the side effects of the drugs which many patients say are often worse than the symptoms of the cancer itself, but also makes the treatment more concentrated and effective.

Because of this effective “plasma barrier” that the pleura creates, oncologists can deliver much more concentrated doses on target, doses that wouldn’t be safe if delivered intravenously. 

However, this study focused on patients that had undergone cytoreductive surgery prior to receiving chemotherapy.  As researchers stated “this strategy has been shown to be effective for peritoneal metastases from appendiceal malignancy, colorectal cancer, and peritoneal mesothelioma.” 

Indeed, the control of “. . . peritoneal mesothelioma in the chest cavity following thoracic cytoreduction and HITOC chemotherapy has approached 100%.”  The authors of the study cite unpublished data that show 30 patients who underwent this form of combined therapy have suffered no recurrence of mesothelioma to date.

Many doctors debate which is the best form of treatment for mesothelioma patients.  However, a growing number have been convinced by the data that suggests some form of limited invasive surgery, rather than removal of the lung, combined with effective, targeted chemotherapy (as opposed to systematic chemotherapy) provides the best combination of solid results with low risk factors. 

Patients who undergo these multimodal forms of treatment have been repeatedly shown to enjoy longer lifespans and better post-surgical quality of life than others.  Still, no two mesothelioma patients are the same and every treatment plan must be catered to the individual patients.  Indeed, some patients may not be good candidates for the more risky surgeries for mesothelioma – typically the more aggressive treatments are reserved for younger and healthier individuals. 

Source:  Pharmacokinetics of Hyperthermic Intrathoracic Chemotherapy following Pleurectomy and Decortication