Intracavitary Chemotherapy

Chemotherapy, radiation or surgery alone is generally ineffective in treating mesothelioma. Combination approaches (multimodality therapy) utilizing these three treatments have shown promise in extending survival of some patients with early disease. However, the tumor occasionally recurs in the same area it was removed and/or in the abdomen.

Intracavitary chemotherapy is a novel chemotherapeutic approach that has been well studied in both thoracic and abdominal cancers. Chemotherapeutic agents (cisplatin) administered directly into the body cavities (chest and/or abdomen) can be administered at much higher doses than if administered systemically (through the bloodstream). The agent may directly enter the tumor cells by diffusion without the toxic effects of high dose systemic intravenous chemotherapy. Heating the chemotherapy (hyperthermia) seems to increase the killing effect of the chemotherapy.

The strategy of intracavitary, heated chemotherapy is one of surgery to the remove the tumor to the microscopic level, then, while still in the operating room under anesthesia (intraoperatively), administer chemotherapy into the chest and abdominal cavity, directly contacting any surfaces that harbor any tumor cells left behind and killing these cells. To protect healthy cells, a ‘cytoprotective’ agent is administered intravenously while the patients is still in the operating room.

Earlier Phase I studies at the Brigham and Women’s Hospital have demonstrated that it is feasible to administer intraoperative, intracavitary, heated cisplatin with a cytoprotective agent and to deliver high doses of cisplatin in this manner. Although these early studies were not designed to evaluate efficacy, the results for patient survival and time to relapse were very encouraging. Phase II evaluation of this therapy is currently ongoing.