Transarterial chemoperfusion is a safe and effective treatment for improving the quality and longevity of life for patients with malignant pleural mesothelioma (MPM), according to Featured Abstract 139, “Transarterial Chemoperfusion Treatment of Unresectable Pleural Mesothelioma: A Phase 2 Prospective Study,” which will be presented Monday, March 6, 4:03 p.m., Room 225AB of the Phoenix Convention Center.
“MPM is a devastating disease of the pleura, the membranes surrounding the lungs, and is very difficult to treat,” said presenter Bela Kis, MD, PhD, associate member in Diagnostic Imaging & Interventional Radiology at Moffitt Cancer Center. “The typical survival rate of patients with stage 3 and 4 MPM is 12 months from diagnosis.”
Due to the poor prognosis and lack of effective treatment for MPM, Dr. Kis said, the researchers sought a novel treatment for patients who failed first-line chemotherapy. By selectively delivering a relatively high concentration of chemotherapy, the treatment’s effect is maximized while causing minimal 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,” said Dr. Kis. “The other two-thirds of the drugs are injected into the descending aorta, which reaches the intercostal vessels that also supply the pleura.”
The study consisted of 32 patients who were enrolled from March 2016–April 2021 and received transarterial chemoperfusion treatment with cisplatin (35 mg/m2), methotrexate (100 mg/m2) and gemcitabine (1000 mg/m2) every 4 weeks. Every patient involved had been heavily pre-treated and experienced relapsed MPM; prior to the study, all patients had previously received chemotherapy, five patients had undergone radiation therapy and three had undergone pleurectomy.
The results of the study showed a 75% disease control rate, and the median progression-free survival was 4.7 months and median overall survival (OS) was 8.9 months from enrollment. Though 30 of the 32 patients died by the data cutoff date of Oct. 10, 2022, there was no treatment-related mortality, and the major complication rate was 1%. Nausea and anemia occurred in 47% of patients, as well as hypomagnesemia (44%), hyperkalemia (41%) and lymphopenia (31%).
With a high disease control rate and OS, the results of the study are promising.
“Transarterial chemoperfusion treatment for advanced mesothelioma is safe and effective and may improve the quality of life of patients,” said Dr. Kis. “It comes with minimal side effects and shows promise for modestly extending the lives of patients who have limited or no remaining treatment options.”
Looking forward, the researchers will be experimenting with alternative dosages and types of chemotherapy drugs used in the treatment.
“I believe the outcomes of chemoperfusion treatment for MPM can be improved by adjusting dosing of the chemotherapy drugs and trying to use new chemotherapy drug combinations,” Dr. Kis said. “This is something we consider initiating a new trial to study.”
