A novel treatment for patients with advanced mesothelioma is safe and effective and may improve the quality of life for patients who have few treatment options, according to a research abstract presented during a virtual session of the Society of Interventional Radiology (SIR) 2020 Annual Scientific Meeting (Abstract 1). Transarterial chemoperfusion treatment for malignant pleural mesothelioma also showed minimal side effects.
“Malignant pleural mesothelioma is a devastating cancer of the pleura, the membranes surrounding the lungs, that is very difficult to treat,” said Bela Kis, MD, PhD, principal investigator on the study and an interventional radiologist at Moffitt Cancer Center. “The typical survival rate of patients with stage III and IV malignant pleural mesothelioma is around 12 months from diagnosis; but with this new treatment, we are hoping we might be able to extend patients’ lives beyond that—giving them more time with friends and family.”
Study Methods
Transarterial chemoperfusion delivers a relatively high concentration of drugs to diseased tissue in the lining of the lungs to maximize the treatment effect with limited side effects. Unlike other chemotherapy that is delivered intravenously and circulates through the entire body, interventional radiologists inject one-third of the triplet of of cisplatin, methotrexate, and gemcitabine directly into the internal mammary artery that supplies the pleura. The other two-thirds of the drugs are injected into the descending aorta, which reaches the intercostal vessels that also supply the pleura. The treatment is an outpatient procedure and typically lasts 1 hour, followed by another hour of recovery.
Twenty-seven patients with malignant pleural mesothelioma were enrolled in the phase II clinical trial and underwent chemoperfusion. All patients had received prior chemotherapy, and many had received multiple lines of chemotherapy. Four of the patients had prior radiation therapy and three patients had pleurectomy. All continued to have disease progression before enrollment.
Results
The interim results of the study show a 70.3% disease control rate and median overall survival rate of 8.5 months from the start of the chemoperfusion treatment. The treatment was well tolerated by patients, with a major complication rate of 1.4%. Most side effects were relatively minor, including mild nausea and chest pain.
“We were pleasantly surprised to find that this treatment doesn’t come with the same side effects of traditional intravenous chemotherapy,” said Dr. Kis.
The researchers are looking to expand their study to other cancer centers with larger malignant pleural mesothelioma patient populations, since the cancer is rare. They also hope to add flexibility to the study to allow for increasing the dosage and changing the combination of medications for individual patients to determine whether either approach could further improve outcomes.
