Chemotherapy has an important role in palliation. It can be administered systemically or directly into the abdomen. The overall response rate reported with a single agent chemotherapy, combined chemotherapy, intraperitoneal chemotherapy, continuous hyperthermic peritoneal mesothelioma perfusion are 13.1%, 20.5%, 47.4%, and 84.6%, respectively.[47] Cisplatin is the most studied agent, with activity in 25% of patients.
Direct exposure of antitumor agent to the peritoneal surface is considered to be most effective against malignant peritoneal mesothelioma. Intraperitoneal chemotherapy can be instilled after surgery or without surgery through an abdominal catheter. Advantages of intraperitoneal chemotherapy include greatly enhanced drug concentrations in the peritoneal cavity and decreased systemic toxicity.
Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion is the standard treatment for resectable tumors at diagnosis. A preheated (42.5 degrees C) perfusate with 2 or 3 antineoplastic agents (cisplatin, mitomycin C, fluorouracil, doxorubicin, and/or paclitaxel) is infused continuously into the closed or semi-closed abdomen after surgery.
In a recent Phase II study[48] with cisplatin, mitomycin C and doxorubicin, the major morbidity rate reported was 12%: the most significant mesotrhelioma complications were anastomotic leaks (11%), abdominal bleeds (1.9%) and sepsis (1.9%). Operative mortality rate was 12%. In another study, after cytoreductive surgery and continuous hyperthermic peritoneal perfusion with
fluorouracil, and paclitaxel, peritoneal mesothelioma progression-free and overall survival were reported to be 17 and 92 months, respectively. Deraco and colleagues reported 5-year overall survival, disease-free survival, and progression-free survival of 70%, 63%, and 51% respectively.[49]
Direct exposure of antitumor agent to the peritoneal surface is considered to be most effective against malignant peritoneal mesothelioma. Intraperitoneal chemotherapy can be instilled after surgery or without surgery through an abdominal catheter. Advantages of intraperitoneal chemotherapy include greatly enhanced drug concentrations in the peritoneal cavity and decreased systemic toxicity.
Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion is the standard treatment for resectable tumors at diagnosis. A preheated (42.5 degrees C) perfusate with 2 or 3 antineoplastic agents (cisplatin, mitomycin C, fluorouracil, doxorubicin, and/or paclitaxel) is infused continuously into the closed or semi-closed abdomen after surgery.
In a recent Phase II study[48] with cisplatin, mitomycin C and doxorubicin, the major morbidity rate reported was 12%: the most significant mesotrhelioma complications were anastomotic leaks (11%), abdominal bleeds (1.9%) and sepsis (1.9%). Operative mortality rate was 12%. In another study, after cytoreductive surgery and continuous hyperthermic peritoneal perfusion with
fluorouracil, and paclitaxel, peritoneal mesothelioma progression-free and overall survival were reported to be 17 and 92 months, respectively. Deraco and colleagues reported 5-year overall survival, disease-free survival, and progression-free survival of 70%, 63%, and 51% respectively.[49]
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