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Published on: December 21, 2019
Treatment of Patients with Malignant Peritoneal Mesothelioma
Claire Y Li1, Timothy Kennedy2, Henry Richard Alexander2
1Department of Surgery, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY 10065, USA.
Abstract:
Malignant peritoneal mesothelioma is a rare malignancy arising from the serosa of the peritoneal cavity. It is diagnosed based on suspicious findings on cross sectional imaging and a tissue biopsy showing confirmatory histologic and immunohistochemical features. The disease is hallmarked by its propensity to progress mainly in the peritoneal cavity. In selected patients, surgical cytoreduction and hyperthermic intra-operative peritoneal chemotherapy has become the initial preferred treatment and is associated with provide prolonged in many patients. Systemic chemotherapy using a couplet of cisplatin or gemcitabine with pemetrexed has modest response rates and duration of response. Expression of PD-L1 has been demonstrated in peritoneal mesothelioma tumors and there has been significant interest in the use of check point blockade targeted against PD-L1 in this clinical setting. Future clinical research using a combination of check point blockade with surgical cytoreduction is a high clinical priority.
Insights
Malignant peritoneal mesothelioma is a rare cancer. Current treatments include surgery with hyperthermic chemotherapy and systemic chemotherapy, with ongoing research into PD-L1 checkpoint blockade.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Oncology
Background:
- Malignant peritoneal mesothelioma is a rare cancer originating from the peritoneum.
- Diagnosis relies on imaging, histology, and immunohistochemistry.
- The disease characteristically progresses within the peritoneal cavity.
Purpose of the Study:
- To review current treatment strategies for malignant peritoneal mesothelioma.
- To highlight the role of surgical cytoreduction and hyperthermic intra-operative peritoneal chemotherapy (HIPEC).
- To discuss the potential of PD-L1 checkpoint blockade in managing this malignancy.
Main Methods:
- Review of existing literature on malignant peritoneal mesothelioma.
- Analysis of diagnostic criteria and treatment modalities.
- Evaluation of systemic chemotherapy response rates.
- Assessment of PD-L1 expression in tumors.
Main Results:
- Surgical cytoreduction with HIPEC offers prolonged survival in selected patients.
- Systemic chemotherapy (cisplatin/gemcitabine with pemetrexed) shows modest response rates.
- PD-L1 expression is present in peritoneal mesothelioma, indicating potential for immunotherapy.
Conclusions:
- Malignant peritoneal mesothelioma requires a multidisciplinary approach.
- HIPEC is a primary treatment option for eligible patients.
- Combining checkpoint blockade with cytoreductive surgery is a promising future direction.
