Transarterial chemoperfusion is safe and feasible in advanced mesothelioma

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transarterialA novel treatment for advanced mesothelioma is safe and effective and may improve the quality of life for patients who have few treatment options, according to a research abstract presented during a virtual session of the Society of Interventional Radiology’s 2020 Annual Scientific Meeting (13–14 June). Transarterial chemoperfusion with cisplatin, methotrexate, and gemcitabine every four weeks is a feasible and safe treatment for patients with relapsed unresectable malignant pleural mesothelioma (MPM). It comes with minimal side effects and shows promise for extending the lives of patients who have limited or no remaining treatment options.

Interim results from a phase 2 prospective study were announced at the SIR Virtual Meeting during an Abstract of the Year session. Presenting on behalf of his fellow researchers, Bela Kis (Moffitt Cancer Center, Tampa, USA), principal investigator of the study, said that the treatment shows a promising disease control rate in heavily pre-treated patients with relapsed MPM.

“MPM is a devastating cancer of the pleura, the membranes surrounding the lungs, that is very difficult to treat,” Kis said. “The typical survival rate of patients with stage 3 and 4 MPM is around 12 months from diagnosis; but with this new treatment, we are hoping we might be able to extend patients’ lives beyond that—giving them more time with friends and family.”

He explained that advanced MPM carries a poor prognosis, and that transarterial chemoperfusion treatment selectively delivers a relatively high concentration of chemotherapy to the targeted tissue’s arterial bed, maximising antitumoural effect and minimising systemic side effects. The study is investigating the disease control rate, overall survival and adverse events of the treatment in patients with relapsed unresectable MPM.

In all, 27 patients with MPM —four females and 23 males, mean age 70.8±6.8 years—were enrolled between March 2016 and June 2019. Patients had transarterial chemoperfusion treatment in every four weeks with cisplatin (35mg/m2), methotrexate (100mg/m2), and gemcitabine (1000mg/m2) via the ipsilateral internal mammary artery and/or descending thoracic aorta. All patients had received and progressed on prior chemotherapy. Four patients had also had radiation therapy, and three patients had had pleurectomy. Response rate was evaluated by modified RECIST for mesothelioma.

Transarterial chemoperfusion delivers a relatively high concentration of drugs to diseased tissue in the lining of the lungs to maximise the treatment effect with limited side effects. Unlike other chemotherapy that is delivered intravenously and circulates through the entire body, interventional radiologists inject one-third of the chemotherapy cocktail of cisplatin, methotrexate, and gemcitabine directly into the internal mammary artery that supplies the pleura. The other two-thirds of the drugs are injected into the descending aorta, which reaches the intercostal vessels that also supply the pleura. The treatment is an outpatient procedure and typically lasts an hour, followed by a one-hour recovery.

The interim results of the study show 70.3% disease control rate and median overall survival rate of 8.5 months from the start of the chemoperfusion treatment. The treatment was well-tolerated by patients with a major complication rate of 1.4%. Most side effects were relatively minor, including mild nausea and chest pain.

“We were pleasantly surprised to find that this treatment doesn’t come with the same side effects of traditional intravenous chemotherapy,” said Kis. “To see these promising results with so few side effects means we are able to make a positive impact on quality of life for these patients.”

Currently, surgery is the only truly effective treatment for MPM, but the disease must be diagnosed early. Only 10–20% of patients are candidates for surgery and often experience surgical complications.

The researchers are looking to expand their study to other cancer centres with larger MPM patient populations, since the cancer is so rare. They also hope to add flexibility to the study to allow for increasing the dosage and changing the combination of medications for individual patients to determine whether either approach could further improve outcomes.

Additional information about the clinical trial is available at ClinicalTrials.gov, using the identifier NCT02611037.

The research was originally scheduled to be presented in person at SIR’s Annual Scientific Meeting, 28 March–2 April, in Seattle, USA, before the meeting was cancelled due to COVID-19 concerns. See all our coverage of the virtual event here.


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