Repeated ambulatory intrapleural chemotherapy for malignant pleural mesothelioma.

Abstract

7088 Background: Malignant pleural mesothelioma (MPM) is associated with a poor prognosis and high mortality rate. Multimodal regimens involving extirpative lung or pleural surgery have had limited success and may be ill-suited for many patients. We offer an alternative multimodal lung-sparing treatment regimen for MPM. Methods: This is a single institution review of 25 patients with advanced MPM who underwent thoracoscopic intrapleural (IP) port placement and were treated with repeated, ambulatory IP chemotherapy (cisplatin and doxorubin). Select patients received concurrent IV pemetrexed and cisplatin or carboplatin. After 8 weeks the pleural space was imaged with radioactive technetium-labeled sulfur colloid. If the distribution was uniform, patients were given 15 mCi IP P-32. Following treatment, catheters were removed, and pleural surfaces were inspected and biopsied by video thoracoscopy. Select patients with progressive disease underwent additional surgery. Statistical analysis was done using Stata/IC 11.0 (Stata Corporation, College Station, Texas). Results: Twenty-five adult patients (20 male, median age 70, range 45-80) underwent ambulatory IP chemotherapy. Eight patients had pleural and peritoneal involvement. Few complications were attributed to IP chemotherapy. Median overall survival time was 12 months (interquartile range 7.7-20.1). Thirteen patients received concurrent IV chemotherapy. This subgroup had an improved median survival of 16.3 months (range 1.3-49.5) vs 10.5 months (5.7-31.8) without IV chemotherapy (p=0.83). Seven patients received IP P-32 radiotherapy. This did not appear to affect survival. Nine patients underwent additional surgery (3 extrapleural pneumonectomy and 6 pleurectomy/ decortication); this did not appear to affect survival (p=0.14). Conclusions: A multimodal approach including repeated IP chemotherapy, IV chemotherapy, and IP radiation is a feasible, safe alternative for select patients with advanced MPM, including those with multicavity disease. This regimen did not prevent patients from undergoing subsequent surgical procedures. More patients are needed to better power subgroups for analysis, improve selection criteria, and optimize treatment.