Chemotherapy “Bath” May Stop Mesothelioma Spread

There is more evidence that washing heated chemotherapy drugs through the open body cavity after mesothelioma surgery may help stop the cancer from spreading. 

A team at the Washington Cancer Institute followed the movement and absorption of these drugs – known as pharmacokinetics – to assess their potential for effectively killing spreading mesothelioma cells without harming healthy tissues.  Specifically, they were studying people who had one of the rarest forms of mesothelioma, called peritoneal mesothelioma. In these patients, mesothelioma in the membrane around their abdominal organs can progress up into the pleural space around the lungs.

During a surgery called pleurectomy and decortication (P/D), the surgeon may remove all or part of the diseased pleural membrane and scrape cancer cells off the surface of the lungs or the walls of the body cavity.  To help kill mesothelioma cells left behind after P/D, surgeons may use hyperthermic intrathoracic chemotherapy.  As with any chemotherapy, the challenge is to destroy mesothelioma cells with as little damage as possible to healthy cells.

To assess hyperthermic intrathoracic chemotherapy’s ability to do that, the Washington Cancer Institute team washed a solution of the chemotherapy drugs mitomycin C and doxorubicin into the body cavity after a P/D operation.  They then monitored the concentration of these agents in the tissues as well as in the blood plasma.

In a summary of their findings, lead study author Paul Sugarbaker writes, “Our results showed a persistent high concentration of intrapleural (around the lungs) drug as compared to plasma concentrations.” When they compared the clearance of the drugs from the body cavity, they found that more chemotherapy medicines stayed in the thoracic (upper body) cavity than stayed in the abdomen and pelvis, suggesting a longer-lasting effect on the pleural mesothelioma cells without too much concentration of the toxic chemicals in the blood.

The authors suggest that these findings provide “a strong pharmacologic rationale” for hyperthermic intrathoracic chemotherapy in people with metastatic peritoneal mesothelioma.  The research appears in the most recent issue of Gastroenterology Research and Practice.