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Updated: Mar 7, 2026
Implantation and Monitoring by PET/CT of an Orthotopic Model of Human Pleural Mesothelioma in Athymic Mice
Published on: December 21, 2019
Long-term regional chemotherapy for patients with epithelial malignant peritoneal mesothelioma results in improved
1Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, DC, USA.
Purpose:
Malignant peritoneal mesothelioma (MPM) is a rare disease with about 300 new cases per year in the USA. Its natural history is described as local progression within the peritoneal space in the absence of liver metastases or systemic disease.
Methods:
Cytoreductive surgery (CRS) is a series of peritonectomy procedures and visceral resections with a goal of complete removal of all visible disease from the abdomen and pelvis. Over 20 years, three protocols investigating increasing efficacy of additional chemotherapy treatments added to CRS have been initiated. Initially, hyperthermic perioperative chemotherapy (HIPEC) with doxorubicin and cisplatin was used in the operating room. Then, early postoperative intraperitoneal chemotherapy (EPIC) with paclitaxel was added for the first 5 days after CRS. The third protocol employed HIPEC, then EPIC, and then long-term intraperitoneal (IP) paclitaxel or IP pemetrexed plus intravenous (IV) cisplatin as a adjuvant normothermic intraperitoneal chemotherapy (NIPEC).
Result:
The 5-year survival of 42 patients treated with CRS and HIPEC was 44%, for 58 patients treated with EPIC and HIPEC was 52% and 29 patients who received HIPEC, EPIC, and NIPEC was 75% (p = 0.0374). Prognostic variables of age, gender, treatment administered, peritoneal cancer index (PCI) and completeness of cytoreduction were significant by univariate analysis and treatments administered and completeness of cytoreduction significant by multivariate analysis.
Conclusions:
Long-term regional chemotherapy was associated with improved survival in patients with MPM. In this rare disease, additional phase 2 investigations are suggested.
Insights
Long-term regional chemotherapy significantly improved survival for malignant peritoneal mesothelioma (MPM) patients. Further phase 2 studies are recommended for this rare cancer.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Oncology
Background:
- Malignant peritoneal mesothelioma (MPM) is a rare malignancy with approximately 300 US cases annually.
- MPM typically progresses locally within the peritoneal cavity, without liver metastases or systemic spread.
Purpose of the Study:
- To evaluate the efficacy of evolving multimodal treatment protocols for malignant peritoneal mesothelioma.
- To assess the impact of cytoreductive surgery (CRS) combined with various intraperitoneal chemotherapy regimens on patient survival.
Main Methods:
- A 20-year study involving three protocols of cytoreductive surgery (CRS) combined with escalating intraperitoneal chemotherapy.
- Protocols included hyperthermic perioperative chemotherapy (HIPEC), early postoperative intraperitoneal chemotherapy (EPIC), and normothermic intraperitoneal chemotherapy (NIPEC) with varying drug combinations (doxorubicin, cisplatin, paclitaxel, pemetrexed).
Main Results:
- Five-year survival rates were 44% (CRS + HIPEC), 52% (CRS + HIPEC + EPIC), and 75% (CRS + HIPEC + EPIC + NIPEC).
- The difference in survival between the groups was statistically significant (p=0.0374).
- Univariate analysis identified age, gender, treatment, peritoneal cancer index (PCI), and completeness of cytoreduction as significant prognostic factors; multivariate analysis confirmed treatment and completeness of cytoreduction.
Conclusions:
- Long-term regional chemotherapy, particularly when combined with CRS and advanced intraperitoneal regimens, is associated with improved survival in MPM patients.
- Further phase 2 investigations are warranted to optimize treatment strategies for this rare peritoneal cancer.
