Intracavitary Chemotherapy
Neither chemotherapy, radiation nor surgery alone is effective in treating mesothelioma. But combination approaches (called multimodality therapy) using all three treatments have offered promise in extending the survival of some patients diagnosed at an early stage of the disease. Still, the tumor occasionally reappears in the same area from which it was removed and/or appears for the first time in the abdomen.
Intracavitary chemotherapy is a new chemotherapeutic tool that is designed to address this problem. Intracavitary chemotherapy has been well studied in both chest and abdominal cancers. Chemotherapy (cisplatin) that is placed directly into the chest and/or abdominal cavity can be given at much higher doses than if the drug were to be administered intravenously through the bloodstream. With intracavitary delivery, the chemotherapy agent is able to directly enter the tumor cells by diffusion without causing the toxic effects associated with intravenous delivery of the same chemotherapy agent. Further, heating the chemotherapy drug (hyperthermia) appears to increase the ability of the chemotherapy to kill off the cancer cells.
Intracavitary, heated chemotherapy is done at the same time as the surgery to the remove the tumor. While the patient is still under anesthesia in the operating room (intraoperatively), the doctors administer chemotherapy into the chest and abdominal cavities, contacting directly any surfaces on which tumor cells may remain and killing these cells. To protect healthy cells nearby, a ‘cytoprotective’ agent is delivered intravenously as part of the same procedure in the operating room.
Phase I studies have shown that chemotherapy agents may be administered to patients in this way. These early studies were not designed to assess the effectiveness of the treatment, but the results for patient survival and time span to relapse were very encouraging.