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Diagnostic and Therapeutic Pathway in Diffuse Malignant Peritoneal Mesothelioma
Shigeki Kusamura1, Dario Baratti1, Michele De Simone2
1Peritoneal Surface Malignancies Unit, Fondazione Istituto Nazionale dei Tumori IRCCS Milano, 20133 Milan, Italy.
Cancers
|February 11, 2023
Summary
Diffuse malignant peritoneal mesothelioma (DMPM) is a rare cancer with poor survival. Optimal treatment involves cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), but patient selection and understanding DMPM biology require further research.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Oncology
Background:
- Diffuse malignant peritoneal mesothelioma (DMPM) is a rare malignancy with a poor prognosis, with a 5-year survival rate of approximately 20%.
- Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offers the best survival outcomes, with median overall survival (OS) ranging from 34 to 92 months for eligible patients.
- Patient selection for CRS and HIPEC is challenging, necessitating thorough preoperative evaluation and risk prediction models.
Purpose of the Study:
- To review the current understanding of DMPM, including prognostic factors and treatment strategies.
- To highlight the complexities in patient selection for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
- To explore emerging research directions, including DMPM biology, novel therapeutic targets, and advanced locoregional treatment technologies.
Main Methods:
- Review of current literature on DMPM diagnosis, prognosis, and treatment modalities.
- Analysis of prognostic factors and risk prediction models for patient selection.
- Exploration of recent advancements in understanding DMPM biology and potential therapeutic strategies.
Main Results:
- Survival is significantly improved with CRS and HIPEC for selected patients.
- Systemic chemotherapy (e.g., Platin compounds with Pemetrexed or immunotherapy) is an option for non-surgical candidates, high-risk patients, or recurrent disease.
- Progress in understanding DMPM biology includes insights into telomere maintenance, apoptosis, tyrosine kinase pathways, and BAP1 mutations.
Conclusions:
- Optimizing patient selection for CRS and HIPEC is crucial for improving DMPM outcomes.
- Further translational research is needed to elucidate DMPM biology and identify new therapeutic targets.
- Investigating novel approaches like immune checkpoint inhibitors and locoregional therapies (PIPAC, NIPEC) holds promise for future DMPM treatment.
