Mesothelioma Slowed by Isolated Thoracic Perfusion Plus Chemofiltration

Sometimes, how mesothelioma chemotherapy is delivered is as important for getting a good result as is which drugs are used. A recent German mesothelioma study attests to the truth of this.

The research involved giving a group of test patients cisplatinum and mitoxantrone through a method called isolated thoracic perfusion with chemofiltration, ITP-F, for short.

At the end of this phase II study, the investigators came away confident that doctors and patients will one day find ITP-F an important therapeutic approach. According to the researchers, ITP-F is “a valuable additional treatment option with low side effects.”

It also can give patients taking it for palliative purposes a reasonable shot at extended mesothelioma survival. And not just give them longer mesothelioma survival, but also a fairly decent quality of life.

Previous Chemo Treatments Didn’t Stop Mesothelioma

The research into ITP-F was conducted at Medias Klinikum Chirurgische Onkologie in Burghausen, Germany. It was presented at the recent American Society of Clinical Oncology annual meeting in Chicago.

The researchers enrolled a total of 23 patients for this study. Of the 23, all but three were men. The median age of the entire cohort was 65.5 years.

All of the patients were identified as having the epithelioid type of malignant pleural mesothelioma. Not quite half of them had previously undergone some form of mesothelioma surgery.

However, every patient in the study had earlier received chemotherapy consisting of cisplatin with pemetrexed. And, in every case, the mesothelioma had started growing again.

The resumption of mesothelioma progress was confirmed by CT scans before starting ITP-F treatment.

ITP-F treatment began with the femoral insertion of venous and arterial stop-flow catheters. These were intended to block the inferior caval vein distal the right atrium and to block the aorta at the diaphragm.

The two catheters were size 21 Charrière, which means they had a diameter of roughly 7mm. The chemotherapy drugs were administered through these catheters.

Administration occurred once every three weeks until disease progress was detected. The dose for the cisplatinum was 60 mg/m2. The dose for the mitoxantrone was 15 mg/m2.

Mitoxantrone is a type II topoisomerase inhibitor. It works by interfering with the synthesis and repair of cell DNA.

The U.S. Food and Drug Administration (FDA) approved mitoxantrone in 2006 for treatment of breast cancer, acute myeloid leukemia, and non-Hodgkin’s lymphoma.

The FDA has also approved mitoxantrone in combination with prednisone to treat metastatic hormone-refractory prostate cancer.

So far, however, the FDA has not approved mitoxantrone for mesothelioma. For now, the FDA allows its use in experiments such as this one by the German researchers.

ITP-F Well-Tolerated by Mesothelioma Patients

In this study, delivery of the cisplatin and mitoxantrone was followed by 15 minutes of thoracic perfusion. In turn, that was followed by 45 minutes of chemofiltration. Both procedures were performed while patients were under general anesthesia.

The researchers reported that patients were able to tolerate the chemotherapy and IPT-F reasonably well. However, there were minor complications from catheter insertion in about 40 percent of the patients.

The researchers were most pleased to find that none of the patients suffered any gastrointestinal toxicity or neurotoxicity.

They were even more pleased to find that half the patients survived at least one full year beyond the start of IPT-F treatment. Indeed, more than one-third of the patients remained alive after three years.

Pleural mesothelioma patients who undergo multimodal therapy don’t have many treatment options available to them when the disease comes back.

That’s why the German researchers are hopeful about ITP-F. They think it may someday offer many mesothelioma patients a chance to keep fighting.