Where Does HITHOC Fit as a Pleural Mesothelioma Treatment?

Hot chemotherapy seems to supplement radical surgery quite well, especially for peritoneal mesothelioma.

For pleural mesothelioma, the feelings are divided.

Numerous reports emerged recently about the merits of HITHOC, an acronym for “hyperthermic intrathoracic chemotherapy.” It’s a form of HIOC, or heated intraoperative chemotherapy. It involves liquid chemotherapy sent into the lung cavity during surgery. The goal is to wash the area to kill any lingering tumors left from surgery.

 

In Favor of HITHOC for Pleural Mesothelioma

One study argued for HITHOC to be included in the guidelines for mesothelioma treatment. Another study showed pensiveness about such a move.

Authors for a study in the Annals of Translational Medicine states HITHOC should be a feature of standard pleural mesothelioma care. It cited numerous past studies with exceptional survival times.

One study demonstrated that using HITHOC improves the average survival for patients receiving surgery by several months (20.5 months versus 16.8 months). The study also demonstrated an improval in 30-day mortality rate for surgery patients (3.2% for people receiving HITHOC versus 6% for people not receiving the therapy).

HITHOC is an option with either surgery for pleural mesothelioma: extrapleural pneumonectomy (lung removed) or pleurectomy with decortication (lung spared).

“Academic centers should take responsibility on a global scale to perform more pilot studies and multicenter large randomized controlled trials to confirm or perform new treatments,” the authors wrote.

“Writers of future guidelines … should therefore be encouraged to discuss and/or include HITHOC as a type of “adjuvant” treatment to be considered after debulking surgery.”

However, this isn’t a unanimous opinion.

 

Unsure of HITHOC for Pleural Mesothelioma

Dr. Raja Flores, the director of thoracic surgical oncology at Mount Sinai Medical Center, is a mesothelioma specialist and surgeon. He co-authored a paper about HITHOC for advanced lung cancer. This type of cancer is similar in many ways to pleural mesothelioma.

“While data suggest a potential, though controversial, role for HITHOC for certain intrathoracic tumors such as malignant pleural mesothelioma and thymoma,” he wrote, “there is insufficient evidence to confidently promote a role for hyperthermic intrathoracic chemotherapy in the treatment of advanced lung cancers.”

Even admitting HITHOC is controversial for pleural mesothelioma proves there are lingering concerns. Dr. Flores and the other author wrote there is uncertainty about “which population of patients would benefit” from HITHOC due to a lack of “randomized controlled trials.”

There is certainly some merit to this belief. The studies cited in favor of HITHOC don’t really point to any benefit from the chemotherapy treatment itself. The survival ranges of 23-35 years are similar to the survival lengths after successful mesothelioma surgery with other adjuvant therapies. This indicates surgery, not HITHOC, is the reason for long survival.

One mesothelioma specialist even said, “There is no good evidence to support (HITHOC).”

It’s clear there are views on each side regarding HITHOC as a pleural mesothelioma treatment. Some believe in the effectiveness to avoid complications and improve survival. Others want more testing and trials before adding it to standard protocols of care.

If you’d like more information about HITHOC and other mesothelioma treatment options, contact registered nurse Karen Ritter. She can help you or your loved one find treatment for a mesothelioma cancer diagnosis. Email her at karen@mesotheliomaguide.com.