Will it work? Maybe. Is it worth exploring? Sure. Is it at the point where it should be widely accepted? That’s another discussion.
Dr. Edward Levine had a similar response to the topic of using NIPEC, a form of postoperative dwell chemotherapy, for peritoneal mesothelioma.
Behind the answer is the important overarching topic: quality of life must be considered when deciding on treatment for mesothelioma. While some experimental therapies have added years of survival for some patients, they may do more harm than good for others.
“If we knew it worked, it wouldn’t be experimental,” he said.
Dr. Levine, a peritoneal mesothelioma surgeon for more than two decades, is the chief of surgical oncology at Wake Forest Baptist Health in Winston Salem, North Carolina. He’s also:
- Senior advisor to the director of the Wake Forest Comprehensive Cancer Center
- Professor of oncology surgical sciences at the Wake Forest School of Medicine
He has many roles. To his patients, he is someone trusted and esteemed. Dr. Levine sees 15‑20 peritoneal mesothelioma patients a year at Wake Forest Baptist Health. His tenure there dates back to the 1990s.
“When I first started treating the disease, there was no HIPEC,” he said. “The outcomes treating this cancer with surgery alone are less than ideal.”
For the hundreds of patients he has treated, quality of life is at the forefront. For many patients, long‑term survival isn’t possible. The tumors have spread too far and are now on the surface of unresectable organs.
“Once long‑term survival isn’t a realistic goal, you want to find the balance between aggressive treatment and quality of life,” he said. “You have to consider that. Not all patients are cured. For the ones not, you want to maintain a high quality of life.”
He then added there’s a balance between “science” and “art” in mesothelioma treatment and surgery. Science involves the specific therapy, the survival rates and the tumor response.
The art side involves quality of life:
- How will the patient respond mentally to treatment?
- What are the side effects of treatment?
- What is the patient’s health and will it get worse due to therapy or surgery?
- Will the treatment actually help?
How long does it take for a doctor and oncologist to find that balance? A few years, at least.
“The learning curve on the physician and hospital side is long unfortunately,” he said, noting it’s usually 30‑50 cases for learning how to treat peritoneal mesothelioma.
“This isn’t a disease where I’d go to a brand new center opening up.”
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