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Current Management and Future Opportunities for Peritoneal Metastases: Peritoneal Mesothelioma

H Richard Alexander1, Claire Yue Li2, Timothy J Kennedy2

  • 1The Rutgers Cancer Institute of New Jersey and the Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. hrichardalexander@gmail.com.

Annals of Surgical Oncology
|February 10, 2018
PubMed
Abstract

Insights

Malignant peritoneal mesothelioma (MPM) is a rare cancer. Surgical cytoreduction with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) offers long-term survival for select patients, with new molecular targets emerging.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Medical Oncology

Background:

  • Malignant peritoneal mesothelioma (MPM) is a rare, fatal cancer originating from the peritoneum.
  • It progresses locoregionally within the abdominal cavity, leading to significant morbidity and mortality.
  • Patients often present with nonspecific symptoms, resulting in late-stage diagnosis.

Purpose of the Study:

  • To review the current scientific understanding of MPM diagnosis, staging, and treatment.
  • To provide an overview of the state-of-the-science for MPM.

Main Methods:

  • Review of retrospective data on MPM diagnosis, staging, and treatment.
  • Analysis of current therapeutic strategies including systemic chemotherapy and surgical interventions.
  • Exploration of emerging molecular targets and immunotherapies.

Main Results:

  • MPM affects men and women equally, typically between ages 55-60.
  • Untreated MPM has a median survival of less than 1 year.
  • Systemic pemetrexed and cisplatin yield a 25% response rate and 1-year median survival.

Conclusions:

  • Operative cytoreduction (CRS) combined with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC) is linked to long-term survival in selected MPM patients.
  • Emerging research highlights the role of PI3K/mTOR pathways and immune checkpoint inhibitors.
  • These molecular insights may lead to novel therapeutic options for diffuse MPM.

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