Peritoneal Mesothelioma Chemotherapy

How Does Chemotherapy for Peritoneal Mesothelioma Work?

Chemotherapy involves delivering cytotoxic (anti-cancer) drugs, or chemicals, into the body to slow or stop the growth and division of cancer cells. It is most often administered intravenously, through an IV drip, and the drugs travel through the bloodstream to areas of the body where cancer cells are developing. Another method is delivering chemotherapy drugs directly into the abdominal cavity where the cancer is forming, this is a surgical procedure.

Cancers like peritoneal mesothelioma grow and spread through rapid cell division. The cells divide and multiply much faster than normal cells, which leads to an overpopulation of mutated cells that eventually spreads and affects vital organs.

Peritoneal mesothelioma forms in the peritoneum, which is the lining of the abdominal cavity. The abdomen includes many important organs, such as the liver, small and large intestines, stomach, spleen, pancreas and more. Some of these organs are vital, and their failure can be deadly.

When the first peritoneal mesothelioma tumors form in the peritoneum, they quickly grow and also cause new tumors to form. The disease spreads in a sheet-like manner, similar to an avalanche, and can quickly reach many of the organs in the abdominal cavity.

Chemotherapy can damage the genes of these cells and disrupt their division, causing the growth and spread to stall.

Types of Chemotherapy for Peritoneal Mesothelioma

The types of peritoneal mesothelioma chemotherapy differ in how the drugs are delivered. The traditional method, called systemic chemotherapy, is given to patients through an IV into the bloodstream. More direct methods deliver the chemotherapy drugs into the abdominal cavity, allowing the medications to bypass the bloodstream and attack the cancer cells where they develop.

Systemic Chemotherapy

Systemic chemotherapy is delivered through an IV into the patient’s vein. The chemotherapy drugs travel through the bloodstream to the cancer cells to stop the growth and division of cells. Systemic chemotherapy can also damage healthy tissue and attack blood cells.

Steps of Peritoneal Mesothelioma Chemotherapy

Chemotherapy is a first line treatment option for peritoneal mesothelioma and, in many studies, it has shown to be effective in slowing the progression of the disease and shrinking mesothelioma tumors. There are several steps that are taken to prepare and select patients for peritoneal mesothelioma chemotherapy.

Here are the steps of peritoneal mesothelioma chemotherapy through an IV into the bloodstream:

The medical team will monitor the patient’s blood pressure, heart rate and temperature before, during and after treatment to ensure the patient’s health is stable and not experiencing any adverse reactions. If there are any concerns or reactions noted, they may recheck the patient’s blood work.

Systemic chemotherapy for peritoneal mesothelioma usually requires multiple sessions with a few weeks of rest in between.

Heated Chemotherapy

Heated chemotherapy involves delivering a solution of heated chemotherapy drugs directly into the abdominal cavity. This is a form of chemoperfusion and involves heating the chemotherapy drugs to more than 100 degrees Fahrenheit.

HIPEC

HIPEC, or hyperthermic intraperitoneal chemotherapy, is an intraoperative (during a surgical procedure) therapy to kill tumors in the abdominal cavity. HIPEC delivers chemotherapy drugs directly into the abdominal cavity. This avoids some of the side effects associated with systemic chemotherapy.

HIPEC is used as part of cytoreductive surgery for peritoneal mesothelioma. Before the incision is closed but after surgical resection, or removal, of all visible tumors and diseased tissues in the abdomen, doctors will heat the chemotherapy solution to a specific temperature.

The surgical team inserts two catheters, or ports, into the patient’s abdomen. These catheters are used to deliver the heated chemotherapy solution directly into the abdominal cavity. The heated liquid remains in the abdomen for approximately 90 minutes, allowing time for full saturation of the tissues in the abdominal cavity.

The medical team then drains the chemotherapy drugs and rinses the abdominal cavity with sterile saline before removing the catheters and closing the incision.

The chemotherapy drugs commonly used for HIPEC are cisplatin, doxorubicin, mitomycin and paclitaxel.

Dwell Chemotherapy

Dwell chemotherapy is an experimental type of treatment for peritoneal mesothelioma. It is another form of chemoperfusion where doctors send the treatment directly into the abdominal cavity, just like for HIPEC.

However, doctors leave the chemotherapy in the abdominal cavity for an extended amount of time and often leave a port in the patient’s abdomen for future sessions. The prolonged exposure to the chemotherapy may improve the chances of tumors and cancer cells being killed.

This type of chemotherapy for peritoneal mesothelioma is still being tested in clinical trials, usually for use after cytoreduction with HIPEC surgery. There are two types of dwell chemotherapy for peritoneal mesothelioma: NIPEC and EPIC.

NIPEC

NIPEC stands for normothermic intraperitoneal chemotherapy. Doctors deliver room-temperature chemotherapy directly into the abdominal cavity, usually a few weeks after peritoneal mesothelioma surgery.

NIPEC involves leaving ports in the patient’s body following surgery. Doctors deliver liquid chemotherapy through the ports and leave it in for multiple days. Patients can also have multiple sessions. This therapy is different from HIPEC, which involves draining the drugs within a couple hours and only allows for one session of treatment.

EPIC

EPIC is another form of NIPEC. It stands for early postoperative intraperitoneal chemotherapy. Patients usually receive EPIC a few days after cytoreductive surgery with HIPEC.

Dwell chemotherapy led to long-term survival in six consecutive cases of peritoneal mesothelioma treated by Dr. Paul Sugarbaker, who is a now-retired former peritoneal mesothelioma specialist.

“Dwell chemotherapy is very important long-term,” he said in an interview with Mesothelioma Guide. “I’ve used HIPEC several thousand times. I’m aware HIPEC has some huge shortcomings. Number one, it’s only used once. It’s just a single treatment. … It’s unlikely that a single dose of cancer chemotherapy will give you a durable response.”

Side Effects of Peritoneal Mesothelioma Chemotherapy

Chemotherapy for peritoneal mesothelioma can cause side effects for patients. There are nearly 50 possible side effects ranging from mild to serious.

Some potential side effects of peritoneal mesothelioma chemotherapy include: 

There are ways to minimize some of these side effects, such as taking short naps regularly to reduce fatigue and regain strength, avoiding fatty foods and drinking plenty of fluids to overcome loss of appetite, and participating in mild exercise to maintain body strength and endurance.

Some of the more serious or long-lasting side effects of peritoneal mesothelioma chemotherapy can include: 

• Itching and rashes
• Bleeding
• Increased risk of infection 
• Damage to organs such as the liver or kidneys
• Low blood counts such as low red and white blood cells
• Inflammation of digestive tract membrane linings

Chemo Brain From Peritoneal Mesothelioma Chemotherapy

Another potential side effect from peritoneal mesothelioma chemotherapy is sometimes referred to as “chemo brain.” This effect is described as a mental cloudiness – a decrease in mental sharpness – caused by chemotherapy treatment. People with chemo brain often have trouble concentrating, finishing tasks, learning new skills, or remembering events or names. This can affect a person’s personal, professional or social life.

Other terms for chemo brain are cancer treatment-related cognitive impairment, cancer-related cognitive change, or post-chemotherapy cognitive impairment. Treatment for chemo brain involves cognitive rehabilitation, physical exercise, and meditation.

Peritoneal Mesothelioma Chemotherapy Survival Rates

The survival rates for peritoneal mesothelioma chemotherapy largely depends on the stage of cancer, method of the treatment and whether it’s used with surgery. Systemic chemotherapy without surgery usually leads to a survival of 1-2 years. Systemic chemotherapy following peritoneal mesothelioma surgery led to a median survival of 41 months (3 years, 5 months).

Heated chemotherapy – such as with HIPEC – is associated with improved survival rates. The National Cancer Database has data on more than 700 cases of peritoneal mesothelioma patients treated with cytoreduction with HIPEC. The average survival was 38 months (3 years, 2 months).

Wake Forest Baptist Cancer Center, which is one of the top cancer centers for peritoneal mesothelioma, had a median survival of 40 months (3 years, 4 months) after a study of cytoreduction and HIPEC patients. The 5-year survival rate was around 30%, and other centers report 5-year survival rates of nearly 50%.

Patients at Wake Forest who had multiple cytoreduction with HIPEC surgeries had even better survival results. The median survival was 4.5 years, the 5-year survival rate was 50%, and patients who received multiple surgeries and HIPEC sessions had a median survival of more than 10 years.

Dr. Paul Sugarbaker reported a 5-year survival rate of 75% after using NIPEC.