Hyperthermic Chemotherapy Mesothelioma Treatment
By Kathy Cooke. 15th Febuary 2021
Patients with pleural mesothelioma can live longer by combining surgery with hyperthermic intrathoracic chemotherapy according to thoracic surgeon Dr. Marcello Migliore.
Dr Migliore is Professor of thoracic surgery at University of Catania and his research includes oncologic trials and the development of new technology and clinical strategies for lung metastases and mesothelioma.
Metastases to the pleural surface from any primary mesothelioma tumour represents a Stage 4 cancer which has a poor prognosis. The treatment options available for such advanced pleural cancer are usually limited to systemic chemotherapy, radiation, and supportive care measures.
However, the surgical removal mesothelioma tumours followed by infusion of hyperthermic chemotherapy may offer significant survival and symptomatic benefit for patients in this disease category. Hyperthermic intrathoracic chemotherapy (HITHOC) involves circulating a heated, high-concentration chemotherapy solution throughout the chest cavity. The idea is to kill any microscopic or minimally visible tumour cells to slow a potential cancer recurrence.
The chemotherapy bathes the inside of the chest in concentrations that are very effective against the mesothelioma cancer cells but without the level of toxicity that could occur if the chemotherapy was given intravenously as used in standard practice. The chemotherapy is more effective from the increased heat that can injure the cancer cells.
Dr Migliore said recently:
“ I have personally seen very good results with it, some unbelievable results with it. We still need a global trial to prove its worth, but more surgeons should be using it now. I want to see more patients benefiting from it. ”
Mesothelioma Guidelines should include HITHOC
Dr Migliore will be publishing a paper in 2021 detailing some of his most recent successes using HITHOC in combination with pleurectomy surgery. Currently, neither The American Society of Clinical Oncology guidelines or The National Comprehensive Cancer Network include HITHOC as a recommended treatment of pleural mesothelioma.
“ This needs to be known by as many patients as possible, as many surgeons as possible, to give more hope to those with pleural mesothelioma . . . We’re not going to cure this disease, but we are going to give these patients a longer survival with this treatment. ”
Questions remain about HITHOC for Pleural Mesothelioma
Less than a third of patients diagnosed with pleural mesothelioma will be eligible for such aggressive surgery and recent studies involving HITHOC have focused on the safety and feasibility of the procedure in the context of complete surgical resection.
Dr Migliore led a recent study in Italy, which compared the results of surgery with HITHC with the more common surgery - talc pleurodesis for mesothelioma patients. Talc pleurodesis is a low-invasive procedure used to treat and prevent pleural effusions, a typical symptom of mesothelioma.
The European Respiratory Journal released the study abstract in October 2020:
The 13 patients that had surgery with HITHOC had an average overall survival of 33 months. The 14 patients not having surgery / HITHOC had an average overall survival of just 19.6 months. 1 and 2 year survival rates were 69% and 54% respectively for those getting HITHOC, compared to 57% and 28.6% for those not getting HITHOC.
Larger Mesothelioma Clinical Trial Required
The benefits of HITHOC after surgery have not yet been proven in a well-controlled, large-number clinical trial. Unlike HIPEC, a similar procedure that has been used effectively to treat peritoneal mesothelioma. This is a common problem in rare procedures for rare diseases as there is no therapy protocol concerning precise techniques. As a result, there have been complications, including complete renal failure.
Dr Migliore continued:
“Yes, I’ve been surprised that more of the big centers are not using this procedure today . . . The guidelines in place today have demonstrated that most treatments for mesothelioma are weak. We can, and should, do better.”
Another thoracic surgeon and mesothelioma specialist, Dr Lang-Lazdunski has been successful in combining aggressive surgery with a pleural lavage of antiseptic povidone-iodine, along with radiotherapy and systemic chemotherapy. Multimodal therapy has been largely recognised as the gold standard for extending survival with pleural mesothelioma.
He is more sceptical :
“ I’ve not seen a survival benefit in controlled trials. This is a different beast than peritoneal mesothelioma. I cannot really see a point in using this method in pleural mesothelioma, a chemo-resistant tumour. ”
If you have recently diagnosed with pleural mesothelioma and would like some advice about claiming compensation, please contact us on the number below and ask for Kathy Cooke or Warren Miller. You can ask a question on our online chat facility or request a call-back and we will contact you at your convenience.
Kathy Cooke MA. BSc(Hons)
Cancer consultant and advisor
Kathy has worked in the cancer field for over 30 years. She was course leader for the MSc in Radiotherapy and Oncology at University of Hertfordshire. Then radiotherapy manager at the Cromwell Hospital in London and Partnership Quality Lead for Macmillan Cancer Support.. Read more >