Clapper, Patti, Schweizer and Mason

Mesothelioma is a malignancy caused by exposure to asbestos that develops in the thin lining of the lungs, abdomen, or heart.  Malignant pleural mesothelioma is the most common.  Several factors affect the prognosis when one is diagnosed with mesothelioma:

·         Treatments

·         Age

·         Stage of disease

·         Histology

·         Overall health of the patient

Treatment, especially given at earlier stages of cancer, can be very effective.  Unfortunately, many cases of mesothelioma are not diagnosed until they are in advanced stages, Stage III and more often Stage IV.  This is due to a couple of factors.  One, there is a long latency period of 10 to 40 years from time of exposure to development of symptoms.  Secondly, the symptoms of mesothelioma are not unique and can mimic those of other more common illnesses, making accurate early diagnosis challenging.

Once diagnosed, if surgery is an option, that will be the first intervention strategy used.  Chemotherapy frequently is started after surgery to reach the cancer that could not be removed.  With mesotheliomas, however, chemotherapy for most patients has only extended life by a few months.  Researchers are looking at ways of delivering chemotherapy and combining it with other modalities to improve its ability to slow progression and increase palliative (symptom) relief.

We recently published an article describing systemic chemotherapy, Systemic Chemotherapy for Mesothelioma, as being one new way that is being investigated and showing some promising results.  The other is Interoperative Hyperthermic Chemotherapy which is used at the site of surgical intervention.  This means that the chemotherapy drug is introduced into the surgical cavity that contains the tumor intraoperative.  In this study, a common chemotherapy agent known as cisplatin was combined with mitomycin C and delivered immediately after performing EPP. 

Study results showed a 40% survival rate at 2 years post-surgery and durable local control of malignancy for 65%.  These percentages are very high for mesothelioma patients, as the median survival time is 6-9 months from time of diagnosis.  Most of the patients in the trial also underwent postoperative radiotherapy.  Given these results, the researchers recommend further studies using hyperthermic intraoperative chemotherapy as one part of a multimodal treatment for mesothelioma and other pleural malignancies.