Peritoneal Mesothelioma Treatment
Peritoneal mesothelioma patients may undergo mesothelioma treatments to extend their lives or to decrease symptoms.
Thankfully for peritoneal mesothelioma patients, mesothelioma specialists have pioneered and refined effective treatments, especially for the 75% of peritoneal mesothelioma patients with the epithelioid cell type.
These treatments mainly consist of surgery and chemotherapy.
In most cases, mesothelioma surgery is the most effective form of treatment for increasing patient life expectancy.
If a patient’s tumors are able to be surgically removed at diagnosis, the standard treatment for peritoneal mesothelioma is cytoreductive surgery (cytoreduction) with hyperthermic intraperitoneal chemotherapy (HIPEC).
Cytoreduction with HIPEC involves two primary steps:
- Cytoreduction: During cytoreductive surgery, doctors open a patient’s abdomen through a large incision and surgically remove as much visible cancer from the patient as possible. Removing the mesothelioma allows chemotherapy drugs to target the remaining cancer more effectively.
- Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Before closing the abdominal cavity, doctors instill heated chemotherapy into it. Once the drugs are given time to work, they are drained and the abdomen is rinsed and closed up.
The 2014 study Malignant Peritoneal Mesothelioma: Prognostic Factors and Oncologic Outcome Analysis found that candidates whose cytoreduction procedure thoroughly removed nearly all visible tumors before undergoing HIPEC lived a median of 56.7 months after surgery.
Candidates whose surgery only partially removed tumors before HIPEC lived for just 7.4 months after surgery.
Despite the surgery’s success, not all peritoneal mesothelioma patients are good candidates for cytoreduction with HIPEC.
Patients are usually good candidates if they:
- Can undergo thorough and complete (not partial) cytoreductive surgery
- Have cancer that has not spread beyond the abdomen
- Have an epithelioid cancer cell type
Many patients with more advanced peritoneal mesothelioma also undergo cytoreduction with HIPEC to reduce the size of their tumors and increase their quality of life.
The 2014 study Malignant Peritoneal Mesothelioma: Prognostic Factors and Oncologic Outcome Analysis suggested that patients with sarcomatoid and biphasic cell types may not benefit from cytoreductive surgery with HIPEC. Their median survival was 10.5 months after surgery versus 51.5 months for those with the epithelioid cell type.
Chemotherapy is a treatment that uses powerful drugs to kill cancer cells. Peritoneal mesothelioma patients who cannot undergo cytoreductive surgery with HIPEC may turn to traditional chemotherapy both to extend their lives and reduce their symptoms.
Doctors may use chemotherapy to treat peritoneal mesothelioma in many ways:
- Shrink tumors: Chemotherapy can decrease the size of a patient’s tumors, relieving symptoms or making the surgical removal of tumors easier.
- Treat non-epithelioid mesothelioma: Patients with biphasic and sarcomatoid cancer cell types do not respond well to a cytoreduction with HIPEC. Since the surgery is invasive, traditional chemotherapy may be a better alternative.
- Treat those not eligible for surgery: Patients who cannot tolerate a cytoreduction with HIPEC often still benefit from chemotherapy.
- Part of cytoreductive surgery with HIPEC: Heated chemotherapy drugs are used during HIPEC, killing cancer cells that doctors cannot detect and physically remove.
As studies into chemotherapy techniques continue, treatment options are expected to expand.
During radiation therapy, doctors use radiation to kill cancer cells. This procedure is not generally used to treat peritoneal mesothelioma because of the many organs that get in the way of the radiation beam.
Clinical Trials and Emerging Treatment
Clinical trials offer peritoneal mesothelioma patients access to emerging treatments that may help them if standard treatment methods are not available to them or are not effective.
Emerging treatment options for peritoneal mesothelioma include:
- Anti-angiogenesis: Anti-angiogenesis involves the use of drugs that block blood vessel growth in cancerous tumors. Without extra blood to support their growth, mesothelioma tumors remain small.
- Chemotherapy advancements: Doctors are hopeful that chemotherapy may be more effective in treating peritoneal mesothelioma by combining conventional chemotherapy with drugs that target specific molecules (targeted therapy) involved in the growth and spread of cancer cells.
- Gene therapy: Gene therapy changes, removes, or adds genes to a patient to help them fight or prevent a disease. Gene therapy’s cancer-fighting potential is broad, and many applications are being tested.
- Immunotherapy: Immunotherapy transforms a patient’s own immune system so that it can effectively find and destroy cancer cells.
Patients with limited traditional treatment options should talk to their doctors about participating in clinical trials.
Palliative treatment seeks to decrease a patient’s pain and discomfort and increase their quality of life rather than helping them live longer.
Peritoneal mesothelioma patients have several palliative treatment options:
- Chemotherapy: This procedure can be used to shrink tumors, reducing symptoms.
- Cytoreduction with HIPEC: In addition to extending life, cytoreductive surgery with HIPEC is an effective palliative treatment for removing the growing tumors that cause an increasing amount of pain and discomfort as peritoneal mesothelioma advances.
- Alternative therapies: Meditation, massage, and other non-medical techniques may also help reduce pain and stress.
Maintaining a high standard of living is an often overlooked but essential part of treatment for peritoneal mesothelioma cancer.