Written By: Devin Golden
Peritoneal Mesothelioma Treatment
Peritoneal mesothelioma treatment is the medical approach to killing peritoneal mesothelioma tumors and improving the life expectancy of people with this rare and aggressive cancer. Treatment options for peritoneal mesothelioma include surgery, chemotherapy and immunotherapy.
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
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Important Facts About Peritoneal Mesothelioma Treatment
- Peritoneal mesothelioma forms in the peritoneum, which is the lining of the abdominal cavity.
- Surgery and chemotherapy are the primary treatment options for peritoneal mesothelioma. Immunotherapy is in testing through clinical trials.
- Top peritoneal mesothelioma specialists can provide cytoreductive surgery with HIPEC for treatment of peritoneal mesothelioma to improve survival and quality of life.
- Mesothelioma Guide’s patient advocates can provide a peritoneal mesothelioma treatment guide to patients and their loved ones or caregivers. We can also help them find a peritoneal mesothelioma specialist.
Top 3 Peritoneal Mesothelioma Treatment Options
The top three treatment options for malignant peritoneal mesothelioma are:
Surgery
Chemotherapy
Immunotherapy
(in clinical trials)
Surgery for peritoneal mesothelioma can significantly improve life expectancy. If surgery is not an option, then patients will typically be offered systemic chemotherapy (through an IV).
Immunotherapy is still in testing through clinical trials, but it is showing signs of helping improve survival compared to chemotherapy.
Peritoneal Mesothelioma Surgery
Surgery for this cancer involves a revolutionary procedure called cytoreduction with HIPEC. This surgery involves a combination of resecting parts of the abdominal cavity – where peritoneal mesothelioma grows and spreads – along with delivering heated chemotherapy to wash the abdominal cavity with cancer-killing drugs.
Cytoreduction and HIPEC Surgery
Cytoreduction and HIPEC surgery is a two-part procedure involving resection and intraoperative chemotherapy. Cytoreduction stands for “debulking.” A debulking procedure removes all visible and accessible tumors.
During a peritoneal mesothelioma cytoreduction, surgeons will remove the peritoneum, omentum (fatty tissue that covers the abdominal organs), and possibly other affected areas or organs, including the spleen, gallbladder and part of the bowel or small intestines.
Before the surgery ends, the medical team delivers heated chemotherapy into the abdominal cavity through catheters. The heated chemotherapy drugs bypass the bloodstream and go directly to the location of the peritoneal mesothelioma.
Paracentesis
Paracentesis is a palliative treatment for peritoneal mesothelioma used to treat one of the cancer’s main symptoms. Paracentesis involves draining the peritoneum of excess fluid. This fluid, called ascites, builds up in the peritoneum and causes abdominal distention and pain. Ascites is a main symptom of peritoneal mesothelioma, and paracentesis can relieve the discomfort.
Paracentesis can be used for patients undergoing aggressive treatment – such as before or after cytoreduction with HIPEC surgery – or patients in hospice care and receiving end-of-life care.
Chemotherapy for Peritoneal Mesothelioma
When peritoneal mesothelioma chemotherapy is administered on its own (without surgery), it is often delivered through an IV and into a vein. This is called systemic chemotherapy. The chemotherapy drugs circulate through the bloodstream and attack peritoneal mesothelioma cancer cells present in the body.
Some patients can have intraperitoneal chemotherapy without undergoing cytoreductive surgery. In these cases, doctors deliver the chemotherapy drugs directly into the abdominal cavity through a hollow tube (catheter).
The most common chemotherapy drugs used for peritoneal mesothelioma are:
- Pemetrexed
- Cisplatin
- Mitomycin
- Doxorubicin
- Paclitaxel
Immunotherapy for Peritoneal Mesothelioma
Immunotherapy for peritoneal mesothelioma is still in testing through clinical trials. The most promising type of immunotherapy for this cancer is called immune checkpoint inhibition.
Peritoneal mesothelioma tumor cells often have specific proteins on the surface of the cells. These proteins can bind with proteins found on the surface of our immune system’s T cells. The binding of the two different proteins can inactivate the T cells and allows peritoneal mesothelioma tumors to grow without restraint.
Immune checkpoint inhibitors – such as Opdivo (nurvalumab), Yervoy (ipilimumab), Keytruda (pembrolizumab) and Imfinzi (durvalumab) – can block these proteins and help the immune system stay active.
Currently, there are no immunotherapy drugs approved by the FDA for peritoneal mesothelioma.
Radiation Therapy for Peritoneal Mesothelioma
Radiation is rarely, if ever, used to treat peritoneal mesothelioma cancer. The abdominal cavity contains many vital organs and radiation is too risky to the health and safety of these organs.
Multimodal Therapy for Peritoneal Mesothelioma
Multimodal therapy for peritoneal mesothelioma involves using a combination of treatments to attack the cancer. The most common form of multimodal therapy is combining surgery and systemic chemotherapy.
For example, peritoneal mesothelioma specialists may suggest patients receive systemic (IV) chemotherapy before cytoreduction and HIPEC surgery. This approach can shrink or slow down the growth of tumors to improve the chances of a successful surgery.
Another option is to have systemic chemotherapy after cytoreductive surgery. This can help kill any remaining peritoneal mesothelioma cells in the abdominal cavity.
Clinical Trials for Peritoneal Mesothelioma
There are clinical trials regularly accepting people with peritoneal mesothelioma or focusing on this cancer. Clinical trials often test new therapies or new approaches to traditional therapies.
Examples of clinical trials for peritoneal mesothelioma include testing gene therapy or targeted therapies – such as anti-VEGF therapies, which prevent the growth of blood vessels that supply oxygen and nutrients to tumors and help them grow. Another example of a peritoneal mesothelioma clinical trial is testing the use of an immunotherapy drug prior to or after cytoreduction/HIPEC surgery.
Frequently Asked Questions About Peritoneal Mesothelioma Treatment
How is Peritoneal Mesothelioma Treated?
Surgery and chemotherapy are standard treatment options for malignant peritoneal mesothelioma. Surgery for peritoneal mesothelioma is cytoreduction with HIPEC, which is a two-part procedure involving debulking of tumors and then delivering heated chemotherapy drugs directly into the abdominal cavity to kill microscopic mesothelioma cancer cells.
Is Radiation Therapy Used for Peritoneal Mesothelioma?
No, radiation is not used for peritoneal mesothelioma. There are many vital organs in the abdominal cavity, and radiation is too risky for the safety of organs such as the liver.
What Other Treatment Options Are Available for Patients With Peritoneal Mesothelioma?
Surgery and chemotherapy are the standard of care for the treatment of peritoneal mesothelioma. There are other treatment options available through clinical trials. Immunotherapy, already approved for pleural mesothelioma, is now the focus of many clinical trials and is a future treatment for peritoneal mesothelioma. Other treatments like gene therapy and anti-VEGF targeted therapies are also being tested in studies.
Sources & Author
- Peritoneal Mesothelioma. Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/diseases/23973-peritoneal-mesothelioma. Accessed: 03/31/2023.
- Treatment of Peritoneal Mesothelioma. Canadian Cancer Society. Retrieved from: https://cancer.ca/en/cancer-information/cancer-types/mesothelioma/treatment/peritoneal-mesothelioma. Accessed: 03/31/2023.
- Update on the management of malignant peritoneal mesothelioma. Translational Lung Cancer Research. Retrieved from: https://tlcr.amegroups.com/article/view/23788/18535. Accessed: 03/31/2023.
