Mesothelioma is a particularly aggressive type of cancer. The average survival for people with the disease is 1-2 years. Even after surgery, survival is limited because doctors often cannot find all the microscopic tumors and cells in the body to remove them.
To achieve a survival lasting seven years or more, patients usually must have surgery so successful that no tumors exist anymore.
One patient didn’t need surgery to achieve this survival. They just needed a novel type of chemotherapy – lots of it.
A male patient diagnosed with peritoneal mesothelioma underwent 24 procedures of pressurized intraperitoneal aerosol chemotherapy, or PIPAC. The length of their survival? Seven years and counting.
What Is PIPAC?
PIPAC is an experimental chemotherapy for cancers in the lining of the abdominal cavity, which is called the peritoneum. Peritoneal mesothelioma starts in this lining, while other cancers can spread there.
PIPAC is a pressurized mist delivered directly into the abdominal cavity rather than through the bloodstream like usual. Doctors create a small incision in the abdomen, a medical procedure called a laparoscopy, and install a port to deliver chemotherapy into the abdominal cavity. The pressure helps the medicine infiltrate cancer tissue and spread more evenly.
According to the Mayo Clinic, patients receive PIPAC every six weeks. The chemotherapy mist stays in the patient’s abdominal cavity for about 30 minutes. The treatment process usually does not require staying overnight in a hospital.
Side Effects of PIPAC
Most side effects from PIPAC are mild and short-term. Patients may feel abdominal pain or cramping, upset stomach, nausea, bloating, loss of appetite, or bowel issues (constipation or diarrhea). These are almost always temporary.
PIPAC vs. HIPEC
HIPEC stands for hyperthermic intraperitoneal chemotherapy. This is a type of chemotherapy where doctors deliver hot, liquid chemotherapy into the abdominal cavity.
HIPEC and PIPAC are similar in both being sent directly into the abdominal cavity. The primary difference is HIPEC is heated and PIPAC is a pressurized mist.
Doctors often combine HIPEC with cytoreductive surgery. Cytoreduction with HIPEC is an aggressive treatment for peritoneal mesothelioma, while PIPAC is not done during surgery. HIPEC also is just done a limited number of times, while PIPAC is repeated every few weeks.
Lastly, HIPEC is considered an aggressive and treatment that can extend survival by several years. PIPAC is used for symptom-control and end-of-life care.
Using PIPAC for Long-Term Survival
What makes this story of long-term survival so interesting is that PIPAC is not usually thought of as a treatment to eliminate cancer. According to the Mayo Clinic, PIPAC is considered a palliative cancer treatment, meaning it’s used to help manage symptoms and, at most, slow the growth of tumors.
Doctors usually turn to PIPAC when surgery is not possible and the cancer has spread past the point of controlling or defeating it. This type of chemotherapy is less toxic than systemic chemotherapy delivered into the bloodstream, so patients may experience fewer side effects and better quality of life.
In the reported case, the patient received PIPAC with doxorubicin and cisplatin and had a stable disease – meaning no tumor growth – within one year. Doctors stopped PIPAC treatment for 2.5 years and restarted it after tumors began growing again. PIPAC again worked, this time giving the patient a stable disease for two years.
“In total, the patient received 24 PIPAC procedures with no major surgical or toxic side effects over seven years,” the report states.
PIPAC for Mesothelioma: Hospitals Offering
PIPAC is an experimental treatment, which means not all hospitals and cancer centers offer this option for mesothelioma. The cancer centers offering PIPAC do so through clinical trials.
An example is a clinical trial titled MESOTIP at a hospital in France. MESOTIP is a randomized trial evaluating PIPAC and systemic chemotherapy versus systemic chemotherapy alone as treatment of peritoneal mesothelioma.
An international clinical trial titled PIPACRegis is testing PIPAC for several peritoneal and pleural cavity diseases. The pleura is a thin tissue lining around the lungs. The other main type of mesothelioma, pleural mesothelioma, forms in the pleura.
Contact Mesothelioma Guide for Help
A diagnosis of peritoneal mesothelioma can be challenging. Many patients struggle to find a doctor who will operate and remove tumors.
Mesothelioma Guide’s team of patient advocates can help you or a loved one find a qualified mesothelioma specialist. They’ll form an individualized treatment plan specifically for your diagnosis. This may involve PIPAC, or other treatment options.
Email lead patient advocate and registered nurse Karen Ritter at karen@mesotheliomaguide.com for immediate assistance.
Sources & Author
- Long-term survival in peritoneal mesothelioma treated with 24 consecutive PIPACs. Pleura and Peritoneum. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/41000443/. Accessed: 09/30/2025.
- Pressurized intraperitoneal aerosol chemotherapy (PIPAC). Mayo Clinic. Retrieved from: https://www.mayoclinic.org/tests-procedures/chemotherapy/in-depth/pressurized-intraperitoneal-aerosol-chemotherapy/art-20584939. Accessed: 09/30/2025.
- Treatment of Malignant Peritoneal Mesothelioma (MESOTIP) (MESOTIP). National Library of Medicine ClinicalTrials.gov. Retrieved from: https://clinicaltrials.gov/study/NCT03875144. Accessed: 09/30/2025.
- International Registry of Patients Treated With Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) (PIPACRegis). National Library of Medicine ClinicalTrials.gov. Retrieved from: https://clinicaltrials.gov/study/NCT03210298. Accessed: 09/30/2025.
