Most people with mesothelioma are, unfortunately, not candidates for surgery. Their disease was caught too late and is too advanced. An aggressive operation — or even traditional chemotherapy — would be too risky.
Those patients have few options remaining, but they should have more.
A new phase 2 clinical trial, hosted by Moffitt Cancer Center in Tampa, Florida, utilized “transarterial chemoperfusion” for advanced pleural mesothelioma. The goal was extending life and improving quality of life, which researchers say they accomplished.
If you have mesothelioma and want to know more about your treatment options, contact our patient advocate team. Our registered nurse, Jenna Campagna, can explain the benefits and drawbacks of each option. She also can help you set up an appointment with a cancer center. Email her at email@example.com.
How Chemoperfusion Rebukes Late-Stage Mesothelioma
In short, chemoperfusion involves delivering chemotherapy directly into the disease location. It’s usually used as a long-term curative method, but the Moffitt Cancer Center study focused more on quality of life and extending life.
“This is for stage 3 and stage 4 and patients who failed first-line chemotherapy,” said Dr. Bela Kis, the lead investigator and co-section head of interventional radiology at Moffitt Cancer Center.
The trial enrolled 27 people with pleural mesothelioma, which is the most common type of mesothelioma. Some of the results of the study included:
- 70.3% disease control rate
- Median overall survival from the start of chemoperfusion treatment of 8.5 months
- Median overall survival from the time of diagnosis of around 28 months, which is an excellent result
Just as significant, side effects were scarce. The treatment was well-tolerated, with only 1.4% of patients having major complications. The most common side effects were mild nausea and chest pain.
Finding Treatment for Most Common Mesothelioma Cases
The clinical trial focused on patients who could not — or refused to — undergo mesothelioma surgery to remove their disease and did not benefit from (or rejected) traditional intravenous chemotherapy treatment. These characteristics describe “advanced” mesothelioma, meaning the cancer is likely already in stage 3 or stage 4.
These cases occur frequently, and transarterial chemoperfusion could be the answer to life-extending treatment with minimal side effects.
According to a study published in the Journal of Thoracic Oncology, most mesothelioma patients are diagnosed with a late-stage disease. Around 48% of patients have stage 3 mesothelioma, and 20% have stage 4 mesothelioma. Only 32% have an early-stage disease.
Most patients need treatments focused on quality of life rather than trying to resect large chunks of tumors.
“Only 10-20% of patients can have surgery,” Dr. Kis said.
How Transarterial Chemoperfusion Works for Pleural Mesothelioma
Transarterial chemoperfusion sends a high concentration of drugs to the diseased tissue in the pleura, which is the lining of the lungs (and where pleural mesothelioma forms). Doctors deliver a chemotherapy combination of cisplatin, gemcitabine and methotrexate into the internal thoracic artery. This artery supplies the pleura’s tissue and cells with oxygen-rich blood.
The rest of the chemoperfusion is sent through the descending aorta, which is part of the largest artery in the human body. The descending aorta connects with blood vessels that also reach the pleura. So the chemotherapy drugs travel a short distance from two entry points into the pleura to attack mesothelioma tumors.
This therapy is different from traditional chemotherapy, which is administered intravenously and travels through the entire body’s bloodstream. The effect on healthy blood cells is reduced due to the shorter travel distance through the body.
Moffitt’s chemoperfusion treatments were monthly sessions, lasting two hours (one for treatment and one for recovery). Patients could continue this treatment for as long as the therapy was safe and effective.
Dr. Kis said one of his patients has taken the treatment for more than four years and still has a stable, controlled disease.
“Most of the patients had a stable disease,” he said. “I think we had one patient with a partial response.”
Show Sources & Author
- Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma Database. Journal of Thoracic Oncology. Retrieved from:
https://www.jto.org/article/S1556-0864(15)33132-4/fulltext. Accessed: 04/14/2020.
- Transarterial Chemoperfusion: Cisplatin, Methotrexate, Gemcitabine for Unresectable Pleural Mesothelioma. Clinicaltrials.gov. Retrieved from:
https://clinicaltrials.gov/ct2/show/NCT02611037. Accessed: 06/18/2020.