The efforts and innovations of mesothelioma researchers have already extended the lives of many patients.
The combination of surgery and chemotherapy has led to survival times of multiple years. Advancing treatment with the use of heated intraoperative chemotherapy has only increased patients’ chances of beating their initial prognosis.
Another progression — dwell chemotherapy — could be the next step forward.
A recent study from Columbia University researchers tested the effectiveness of dwell chemotherapy for malignant peritoneal mesothelioma. “Adjuvant treatment” is defined as the method of care occurring after the primary one, which is usually surgery.
Last year, Mesothelioma Guide analyzed the merits of heated intraoperative chemotherapy as an adjuvant mesothelioma treatment. Now we’re examining dwell chemotherapy.
If you’re a mesothelioma patient and want to learn more about advancements of chemotherapy and how to receive one of these treatments, email patient advocate and registered nurse Jenna Campagna (firstname.lastname@example.org).
What Is Dwell Chemotherapy?
Traditional chemotherapy involves intravenous administration (infusion into a vein in the arm or chest). However, cancer experts are using alternative methods for delivering the cancer-killing drugs into the patient’s body.
Dwell chemotherapy involves two catheters inserted into the targeted area for the cancer treatment. Patients receive continuous chemotherapy doses directly to the location of the cancer. The drug then stays inside the patient’s body for multiple days, which means tumors are exposed and attacked for an extensive amount of time.
Cancer doctors (oncologists) use adjuvant treatments like dwell chemotherapy to kill remaining cancer cells not found during surgery or to prevent recurrence of the disease. Both uses are essential, especially for treating mesothelioma.
This cancer is comprised of many microscopic tumors, and removing all of them during surgery is challenging. Mesothelioma also has a high rate of recurrence. Therefore, adjuvant treatment is essential to patients’ long-term survival.
Comparing Dwell Chemotherapy and HIPEC
Dwell chemotherapy is similar in many ways to heated intraperitoneal chemotherapy (HIPEC), which is a cornerstone treatment for peritoneal mesothelioma. HIPEC involves hot liquid chemotherapy administered directly into the abdomen, which is near where peritoneal mesothelioma forms.
While similar to HIPEC, dwell chemotherapy is not an intraoperative treatment. Instead, it’s administered weeks after the surgery. Dwell chemotherapy also isn’t heated or drained from the patient’s body within a few hours like HIPEC.
“We believe that if you let it dwell, then it could go further (deeper) into the tumors,” said Josh Leinwand, a general surgery resident at Columbia University who was involved in the study. “I think dwell chemotherapy is a good modality for this disease.”
The Columbia University study focused on peritoneal mesothelioma. Leinwand said that his institution has used dwell chemotherapy for pleural mesothelioma, too. So it could be an adjuvant treatment for all people with mesothelioma.
“We’re not the only ones looking at it, either,” Leinwand said. “There are other places looking at dwell chemotherapy (for pleural mesothelioma).”
Dwell Chemotherapy Methodology in the Study
Administering dwell chemotherapy in the Columbia University study took a couple of hours — one hour to give the patient the drug and another hour to examine for side effects. For the next week, the drug penetrated the patients’ tumors.
The study’s final report states that dwell chemotherapy consisted of four doses of cisplatin alone or cisplatin plus gemcitabine, alternating with four doses of doxorubicin. Each alternating dose cycle lasted three weeks, for a total of 12 weeks of dwell chemotherapy.
Before receiving dwell chemotherapy, participants started with cytoreduction and HIPEC. That standard form of care for peritoneal mesothelioma has led to survival times of multiple years. However, cytoreduction also has a high rate of complications and even mortality.
The researchers for this study planned for participants to undergo two rounds of cytoreduction with HIPEC, one before the dwell chemotherapy doses and one after. Doing so meant a less intense resection during the first cytoreduction and a potentially shorter hospital stay for the patient.
“At second-look operation, if residual tumor was present, cytoreduction with the objective of complete resection of all tumor burden was performed prior to HIPEC,” the report states. “… This approach has been previously demonstrated to reduce major visceral resections, lengthy hospitalizations, and requirements for chest tubes and parenteral nutrition.”
Leinwand said mesothelioma is “a difficult disease to image,” and the second look provided the team “an opportunity to look for participant disease” and see if a recurrence occurred.
Results of Dwell Chemotherapy Study
There were 204 participants in Columbia University’s study. Of them, 148 received dwell intraperitoneal chemotherapy and 128 were eligible for a second cytoreduction with HIPEC.
The survival-time difference is extraordinary for those who received dwell chemotherapy and those who didn’t. The patients who had dwell chemotherapy survived for a median of 54 months. Those who didn’t receive the treatment survived for a median of just four months.
“The big takeaway for me was the big survival for patients with dwell,” Leinwand said.
Some additional factors contributed to the difference in median survival time. Any patient who had surgical complications and died during or soon after the operation would skew the gap since they wouldn’t have had dwell chemotherapy. However, severe complications only occurred for a few patients, and the research still shows dwell chemotherapy extending lives by multiple years.
Patients who had HIPEC during their first operation survived for a median of three years. Patients who didn’t receive HIPEC at this time — due to one of many reasons — survived for around 16 months.
The report also indicates HIPEC was not a predictor of prolonged survival. The report states that resectability of the disease (whether it could be removed during surgery) was a better explanation for survival.
“It’s an interesting question: Why does one dose of HIPEC work?” Leinwand asked rhetorically. “I think (dwell chemotherapy) is akin to systemic chemotherapy. It makes sense that you need multiple rounds of chemotherapy to have the maximum effect.”
The report concluded that “cytoreductive surgery with intraoperative and dwell intraperitoneal chemotherapy is a feasible approach” to treating malignant peritoneal mesothelioma. Additionally, “expanded access to these therapies may offer benefit to a larger population of patients” and “dwell intraperitoneal chemotherapy is associated with longer overall survival.”
Dwell chemotherapy is not a routine mesothelioma treatment among United States cancer centers. Maybe it should be.