Long-term mesothelioma survival is rare, mainly due to how stubborn and aggressive this cancer usually is.
Lengthy survival in consecutive cases is nearly unheard of, but a recent report gives hope to the future of mesothelioma treatment.
Two doctors, one being a mesothelioma specialist, co-authored a report on six patients with “unusually favorable outcomes” after aggressive therapy. All six had peritoneal mesothelioma and underwent the same — or very similar — treatment protocols: surgery and heated/hyperthermic intraperitoneal chemotherapy (HIPEC).
That’s a standard combination for this form of mesothelioma. The unique aspect is what occurred after HIPEC.
The patients underwent dwell chemotherapy, which other researchers have promoted as a potential treatment for peritoneal mesothelioma. Dwell chemotherapy is a long-term form of the treatment. Another name for it is normothermic intraperitoneal chemotherapy (NIPEC).
The results were incredible for these six cases. All of them survived for at least eight years, and most are still alive as of this article’s publication date.
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Six Peritoneal Mesothelioma Success Stories
Dr. Paul Sugarbaker — a peritoneal mesothelioma surgeon and the brother of the late Dr. David Sugarbaker, a pleural mesothelioma specialist — and his team followed the same process for all six patients. They were all diagnosed with diffuse malignant peritoneal mesothelioma, meaning their cancer has spread well into the abdomen.
“It does have some ramifications for additional clinical studies,” Dr. Sugarbaker said.
All were deemed to have the epithelioid cell type and followed the same treatment plan. The six underwent mesothelioma cytoreduction with HIPEC. Cytoreduction involves removing the peritoneum and any other visible tumors. The peritoneum is the thin protective membrane near the abdominal cavity.
Doctors placed an intraperitoneal port for further chemotherapy administered directly into the abdominal space. This port is how doctors can administer NIPEC/dwell chemotherapy.
At first, the patients went between three and six one-week-long cycles of the chemotherapy drug “paclitaxel.” In 2004, the United States Food and Drug Administration approved pemetrexed plus cisplatin for mesothelioma. Dr. Sugarbaker said the study shifted to use intraperitoneal pemetrexed in the one-week-long cycles.
Four patients had complete disease response and were “free of their disease” after 8, 13, 18 and 19 years. Two of the patients died after surviving for 15 years. Their average survival time, as of June 2020, is approximately 15 years.
“It was one of those things where you follow up with the patients and it was an isolated cell of patients,” Dr. Sugarbaker said. “Then all of the reports of long-term benefits of paclitaxil came about for various diseases.”
By comparison, the median survival for peritoneal mesothelioma cases is around two years. People who undergo cytoreduction with HIPEC have survival rates of between three and five years.
What Is Dwell Chemotherapy for Mesothelioma?
Dwell chemotherapy, also called NIPEC, is an emerging cancer treatment that involves leaving the chemotherapy in the body for multiple hours or days. Dwell chemotherapy for mesothelioma utilizes aspects of HIPEC and intravenous mesothelioma chemotherapy.
However, dwell chemotherapy has benefits over HIPEC and intravenous chemotherapy.
The drug is administered at a normal temperature through two catheters, which go directly into the mesothelioma’s location. Since the medicine doesn’t travel through the blood circulatory system, it has fewer negative effects on healthy cells.
The dwell aspect of the treatment involves the drug remaining in the body for multiple hours or days. The tumors are exposed to chemotherapy and targeted for an extensive amount of time. HIPEC involves draining the heated chemotherapy after a few hours immediately following cytoreductive surgery.
Dr. Sugarbaker and his team had 29 total patients who underwent cytoreduction plus HIPEC and a form of dwell chemotherapy. The six aforementioned survival cases occurred consecutively in that 29. In total, the five-year survival rate for the whole group was an astounding 75%.
“It became a protocol for us,” Dr. Sugarbaker said.