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Kepenekian V, Sgarbura O, Marchal F, Villeneuve L, Kusamura S, Deraco M. 2022 PSOGI Consensus on HIPEC Regimens for Peritoneal Malignancies: Diffuse Malignant Peritoneal Mesothelioma. Ann Surg Oncol 2023; 30:7803-7813. [PMID: 37481492 DOI: 10.1245/s10434-023-13973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/04/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and aggressive primary peritoneal disease, with recommended treatment, in eligible patients, of a combination of complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). As treatment is multimodal, there is a wide heterogeneity of HIPEC protocols precluding clear comparisons. Standardization at an international level is required. METHODS The Peritoneal Surface Oncology Group International (PSOGI) designated a steering committee to produce consensus recommendations for HIPEC regimens, adapted to each etiology. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology was used, based on a systematic review focused on main outcomes related to HIPEC regimens in DMPM patients and on the patient, intervention, comparator, and outcome (PICO) method to elaborate main questions. An opinion survey was added. Furthermore, a Delphi process was performed with voting from a panel of international experts. RESULTS Eleven questions were elaborated, including two for future research requirements and three to assess the HIPEC regimen preference of the panel. The level of evidence underlying questions was globally low. Overall, 75 (86%) and 67 (77%) of the 87 invited experts completed the vote at the first and second round, respectively. HIPEC following complete CRS was strongly supported by 88% of voters with no need to plan comparative studies with CRS alone for 61.2% of voters. Bi-drug regimens appeared to be preferred to mono-drug ones and cisplatin was globally favored. The opinion survey confirmed the combination of cisplatin and doxorubicin as the recommended regimen. CONCLUSION International consensus confirmed the indication of HIPEC following complete CRS in DMPM patients and recommended cisplatin-doxorubicin as the first-line HIPEC regimen.
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Affiliation(s)
- Vahan Kepenekian
- Service de Chirurgie Oncologique et Digestive, Hospices Civils de Lyon, Hôpital Lyon Sud, Université Lyon-1, Pierre-Bénite, Oullins, France.
- Faculté de Médecine Lyon-Sud, CICLY, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
| | - Olivia Sgarbura
- Surgical Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Frederic Marchal
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Université de Lorraine, Nancy, France
| | - Laurent Villeneuve
- Faculté de Médecine Lyon-Sud, CICLY, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Service de Recherche et d'Epidémiologie Cliniques, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Shigeki Kusamura
- Peritoneal Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcello Deraco
- Peritoneal Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Alberto Vilchez ME, Pachmayr E, Arnold A, Gül-Klein S, Brandl A, Rau B. Synchronous Pleural and Peritoneal Mesothelioma: a Case Report and Narrative Review. Indian J Surg Oncol 2023; 14:97-105. [PMID: 37359943 PMCID: PMC10284771 DOI: 10.1007/s13193-022-01637-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022] Open
Abstract
Malignant mesotheliomas most often affect the pleura and tend to spread locally within the originating cavity. Mesotheliomas are already rare diseases, and cases with synchronous pleural and peritoneal involvement are scarce in the literature. Mesothelioma in children is a rare disease representing only 0.9% of all mesotheliomas. They exhibit similar distribution and characteristics as mesotheliomas in adults and generally, a poor prognosis. Due to the rarity, there is no standardized treatment recommendation for children with mesothelioma. Though the malignant mesothelioma tends to spread locally within the originating cavity, pleuM have been reported to metastasize into the peritoneal cavity and vice versa. As there are only few studies concerning the metastatic spread of mesothelioma, it is difficult to define a precise incidence and risk factors for patients to develop metastases of the other mesothelium. There is no standardized therapeutic recommendation for patients with synchronous pleuM and perM. Our patient proved to profit from a radical two-stage surgical approach in combination with locoregional chemotherapy; she showed no sign of tumor recurrences 9 years after tumor resection. In conclusion, clinical studies are needed to confirm the benefit of this treatment and to determine its limitations and selection criteria.
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Affiliation(s)
- Miguel Enrique Alberto Vilchez
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Eva Pachmayr
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Alexander Arnold
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Safak Gül-Klein
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Andreas Brandl
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Beate Rau
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Ripley RT, Holmes HM, Whitlock RS, Groth SS, Medina CG, Choi EA, Burt BM, Sugarbaker PH. Pleurectomy and decortication are associated with better survival for bicavitary cytoreductive surgery for mesothelioma compared with extrapleural pneumonectomy. J Thorac Cardiovasc Surg 2023; 165:1722-1730. [PMID: 36740497 DOI: 10.1016/j.jtcvs.2022.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Mesothelioma is a nearly uniformly fatal tumor. Multimodality therapy including cytoreductive surgery and chemotherapy is associated with long-term survival in some patients. Cytoreductive surgery for thoracic disease includes a lung-sparing operation called an "extended pleurectomy/decortication" or a lung-sacrificing surgery called an "extrapleural pneumonectomy." The benefit of cytoreductive surgery for bicavitary disease (chest and abdomen) is poorly understood. Our objective was to evaluate the long-term survivals for patients undergoing cytoreductive surgery for bicavitary disease and to determine whether any prognostic factors were associated with outcome. METHODS We reviewed our Institutional Review Board-approved, institutional, International Association for the Study of Lung Cancer Mesothelioma Staging Project database. Inclusion criteria were all patients who underwent cytoreductive surgery for bicavitary disease. Overall survival was calculated by Kaplan-Meier methodology. All International Association for the Study of Lung Cancer database elements were evaluated by univariable analysis. RESULTS From February 2014 to August 2021, 440 patients with mesothelioma were evaluated. Fourteen patients (3%) underwent cytoreductive surgery of both chest and abdomen as a planned 2-stage operation. Most patients (13/14; 93%) underwent chest surgery before abdomen surgery. For the entire cohort, the median overall survival was 33.6 months with a 5-year survival of 20%. Extended pleurectomy/decortication was associated with a better outcome compared with extrapleural pneumonectomy, with median overall survivals of 58.2 versus 13.5 months, respectively. CONCLUSIONS For a highly selected group of patients with bicavitary mesothelioma, long-term survival can be achieved with an aggressive, staged surgical approach. The patients who undergo extended pleurectomy/decortication with preservation of the lung appear to have more favorable outcomes compared with patients undergoing extrapleural pneumonectomy.
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Affiliation(s)
- R Taylor Ripley
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - Hudson M Holmes
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Richard S Whitlock
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Shawn S Groth
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Cristian G Medina
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Eugene A Choi
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Paul H Sugarbaker
- Center for Gastrointestinal Malignancy, MedStar Washington Hospital Center, Washington, DC
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Substance GP-2250 as a New Therapeutic Agent for Malignant Peritoneal Mesothelioma—A 3-D In Vitro Study. Int J Mol Sci 2022; 23:ijms23137293. [PMID: 35806313 PMCID: PMC9267014 DOI: 10.3390/ijms23137293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Malignant peritoneal mesothelioma is a rare tumor entity. Although cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have increased overall survival, its prognosis remains poor. Established chemotherapeutics include mitomycin C (MMC) and cisplatin (CP), both characterized by severe side effects. GP-2250 is a novel antineoplastic agent, currently under clinical investigation. This in vitro study aims to investigate effects of GP-2250 including combinations with CP and MMC on malignant mesothelioma. JL-1 and MSTO-211H mesothelioma cell lines were treated with increasing doses of GP-2250, CP, MMC and combination therapies of GP-2250 + CP/MMC. Microscopic effects were documented, and a flow-cytometric apoptosis/necrosis assay was performed. Synergistic and antagonistic effects were analyzed by computing the combination index by Chou-Talalay. GP-2250 showed an antiadhesive effect on JL-1 and MSTO-211H spheroids. It had a dose-dependent cytotoxic effect on both monolayer and spheroid cultured cells, inducing apoptosis and necrosis. Combination treatments of GP-2250 with MMC and CP led to significant reductions of the effective doses of CP/MMC. Synergistic and additive effects were observed. GP-2250 showed promising antineoplastic effects on malignant mesothelioma cells in vitro especially in combination with CP/MMC. This forms the basis for further in vivo and clinical investigations in order to broaden treatment options.
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Gulmez S, Polat E, Duman U, Senger AS, Uzun O, Ozduman O, Oz A, Subasi IE, Duman M. Hepatic bridge and round ligament of the liver during cytoreductive surgery: a retrospective cohort. Langenbecks Arch Surg 2021; 407:1201-1207. [PMID: 34845541 DOI: 10.1007/s00423-021-02386-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The hepatic bridge as an anatomical variation may lead to recurrence and treatment failure in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by constituting an obscure region during surgery. This report aimed to highlight the relationship between the hepatic bridge and various prognostic factors in peritoneal carcinomatosis. METHODS Data of 101 patients who underwent CRS/HIPEC for peritoneal carcinomatosis in a single centre were retrospectively reviewed. Demographic characteristics, primary origin of peritoneal carcinomatosis, classification of hepatic bridge, Peritoneal Cancer Index (PCI) score, and completeness of cytoreduction (CC) score were analysed. RESULTS The tumour was proven histopathologically in 18 (28.6%) of 63 patients who underwent distal round ligament (DRL) resection. The PCI score was found to be significantly higher in patients with tumour in DRL compared to the ones without tumour (p < 0.001). The median PCI score of patients with implant positive DRL was 18 (12-20) and this score was 3 (2-6) for patients with implant negative DRL (p < 0.001). The ROC curve concerning the risk of an implant penetrating the round ligament revealed the optimal cut-off value of PCI at 10 with 88.9% sensitivity and 79.3% specificity. CONCLUSION The round ligament should be removed, regardless of the PCI score, as a standard in mucinous adenocarcinoma of the appendix and malignant peritoneal mesothelioma. DRL should be removed when PCI is equal or higher than 10 for PC due to colorectal and ovarian cancers.
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Affiliation(s)
- Selcuk Gulmez
- Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Erdal Polat
- Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Ugur Duman
- Department of General Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, SBU, Bursa Yuksek Ihtisas EAH, Mimar Sinan Mahallesi, Emniyet Caddesi, 16310, Yildirim, Bursa, Turkey.
| | - Aziz Serkan Senger
- Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Orhan Uzun
- Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Omer Ozduman
- Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Oz
- Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Ismail Ege Subasi
- Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Duman
- Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey
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Kusamura S, Kepenekian V, Villeneuve L, Lurvink RJ, Govaerts K, De Hingh IHJT, Moran BJ, Van der Speeten K, Deraco M, Glehen O. Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. Eur J Surg Oncol 2020; 47:36-59. [PMID: 32209311 DOI: 10.1016/j.ejso.2020.02.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- S Kusamura
- Department of Surgery, Peritoneal Surface Malignancy Unit, Fondazione IRCCS Instituto Nazionale Dei Tumori di Milano, Via Giacomo Venezian 1, Milano, Milan, Cap 20133, Italy
| | - V Kepenekian
- Service de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - L Villeneuve
- Service de Recherche et Epidémiologie Cliniques, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - R J Lurvink
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - K Govaerts
- Department of Surgical Oncology, Hospital Oost-Limburg, Genk, Belgium
| | - I H J T De Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - B J Moran
- Peritoneal Malignancy Institute, North-Hampshire Hospital, Basingstoke, United Kingdom
| | - K Van der Speeten
- Department of Surgical Oncology, Hospital Oost-Limburg, Genk, Belgium
| | - M Deraco
- Department of Surgery, Peritoneal Surface Malignancy Unit, Fondazione IRCCS Instituto Nazionale Dei Tumori di Milano, Via Giacomo Venezian 1, Milano, Milan, Cap 20133, Italy.
| | - O Glehen
- Department of Digestive Surgery, Centre Hospitalier Lyon Sud, Lyon, France
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Leinwand JC, Taub RN, Chabot JA, Kluger MD. Two-Stage Cytoreductive Surgery and Intraperitoneal Chemotherapy for Diffuse Malignant Peritoneal Mesothelioma: Predictors of Overall Survival in an Intention-to-Treat Series. Ann Surg Oncol 2019; 27:2539-2547. [PMID: 31832913 DOI: 10.1245/s10434-019-08139-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE Cytoreductive surgery with intraoperative hyperthermic intraperitoneal chemotherapy is standard of care for diffuse malignant peritoneal mesothelioma (DMPM), but there is variability among institutions in the administration of adjuvant chemotherapy. Characterization of the largest series of DMPM patients treated at a single institution and identification of the demographic, disease, and treatment factors associated with overall survival were sought. PATIENTS AND METHODS All DMPM patients who underwent initial cytoreductive surgery with the intention to undergo intraperitoneal chemotherapy and a second-look operation from 1995 to 2016 at our institution were retrospectively reviewed. The primary endpoint was overall survival. RESULTS A total of 204 DMPM patients underwent initial cytoreduction. Median overall survival was 32 months from initial cytoreduction. Independent baseline prognostic factors of improved overall survival were female sex, age < 60 years, and epithelioid histology. Independent treatment factors associated with improved overall survival were attempted resection at initial operation, residual disease < 0.5 cm at the end of the initial operation, and dwell intraperitoneal chemotherapy. CONCLUSIONS Cytoreductive surgery with intraoperative and dwell intraperitoneal chemotherapy is a feasible approach for DMPM. Expanded access to these therapies may offer benefit to a larger population of patients. Demographic and operative parameters associated with overall survival in this large cohort are consistent with previous reports. In the context of this treatment protocol, dwell intraperitoneal chemotherapy is associated with longer overall survival.
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Affiliation(s)
- Joshua C Leinwand
- Gastrointestinal and Endocrine Surgery, Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Robert N Taub
- Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - John A Chabot
- Gastrointestinal and Endocrine Surgery, Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Michael D Kluger
- Gastrointestinal and Endocrine Surgery, Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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de Boer NL, van Kooten JP, Damhuis RAM, Aerts JGJV, Verhoef C, Madsen EVE. Malignant Peritoneal Mesothelioma: Patterns of Care and Survival in the Netherlands: A Population-Based Study. Ann Surg Oncol 2019; 26:4222-4228. [PMID: 31620941 PMCID: PMC6864027 DOI: 10.1245/s10434-019-07803-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare and aggressive disease. Recently, focus has shifted toward a more aggressive and multimodal treatment approach. This study aimed to assess the patterns of care and survival for MPM patients in the Netherlands on a nationwide basis. METHODS The records of patients with a diagnosis of MPM from 1993 to 2016 were retrieved from the Dutch Cancer Registry. Data regarding diagnosis, staging, treatment, and survival were extracted. Cox regression analyses and Kaplan-Meier survival curves were used to study overall survival. RESULTS Between 1993 and 2016, MPM was diagnosed for 566 patients. Overall, the prognosis was very poor (24% 1-year survival). The most common morphologic subtype was the epithelioid subtype (88%), followed by the biphasic (8%) and sarcomatoid (4%) subtypes. Surgical treatment has become more common in recent years, which most likely has resulted in improved survival rates. In this study, improved survival was independently associated with hyperthermic intraperitoneal chemotherapy (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.21-0.55) and surgery with adjuvant systemic chemotherapy (HR, 0.33; 95% CI, 0.23-0.48). Nonetheless, most patients (67%) do not receive any form of anti-cancer treatment. CONCLUSION This study indicated that MPM still is a rare and fatal disease. The survival rates in the Netherlands have improved slightly in the past decade, most likely due to more aggressive treatment approaches and increased use of surgery. However, most patients still do not receive cancer-directed treatment. To improve MPM management, and ultimately survival, care should be centralized in expert medical centers.
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Affiliation(s)
- Nadine L de Boer
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Job P van Kooten
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ronald A M Damhuis
- Department of Research, Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Eva V E Madsen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
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Heller DR, Chiuzan C, Taub RN, Leinwand JC, Greene AM, Bates GE, Chabot JA, Kluger MD. Recurrence of Optimally Treated Malignant Peritoneal Mesothelioma with Cytoreduction and Heated Intraperitoneal Chemotherapy. Ann Surg Oncol 2017; 24:3818-3824. [DOI: 10.1245/s10434-017-6106-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Indexed: 01/06/2023]
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Kim J, Bhagwandin S, Labow DM. Malignant peritoneal mesothelioma: a review. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:236. [PMID: 28706904 DOI: 10.21037/atm.2017.03.96] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mesothelioma is a malignancy of serosal membranes. It is most commonly encountered in the visceral pleura with the second most common location in the peritoneum. The diagnosis is very rare and has been linked to toxic exposure to industrial pollutants, especially asbestos. Malignant peritoneal mesothelioma (MPM) commonly presents with diffuse, extensive spread throughout the abdomen with rare metastatic spread beyond the abdominal cavity. Due to its rarity and nonspecific symptoms, it is usually diagnosed late when the disease burden is extensive. Because pleural mesothelioma is more common than MPM, most research has been on the pleural variant and extrapolated for MPM. While treatment advances have been made for MPM, the disease is universally fatal from either abdominal complications secondary to the spread of disease or starvation. Untreated, the life expectancy is less than a year. Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) has become the mainstay of therapy with systemic therapies still being developed. We will review the epidemiology of MPM and discuss diagnostic and treatment strategies.
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Affiliation(s)
- Joseph Kim
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanel Bhagwandin
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Leinwand JC, Chabot JA, Kluger MD. Preventing recurrence of diffuse malignant peritoneal mesothelioma. Expert Rev Anticancer Ther 2016; 16:989-95. [DOI: 10.1080/14737140.2016.1220305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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12
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Spanò V, Pennati M, Parrino B, Carbone A, Montalbano A, Cilibrasi V, Zuco V, Lopergolo A, Cominetti D, Diana P, Cirrincione G, Barraja P, Zaffaroni N. Preclinical Activity of New [1,2]Oxazolo[5,4-e]isoindole Derivatives in Diffuse Malignant Peritoneal Mesothelioma. J Med Chem 2016; 59:7223-38. [PMID: 27428868 DOI: 10.1021/acs.jmedchem.6b00777] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A series of 22 derivatives of the [1,2]oxazolo[5,4-e]isoindole system were synthesized through an efficient and versatile procedure that involves the annelation of the [1,2]oxazole moiety to the isoindole ring, producing derivatives with a wide substitution pattern. The structure-activity relationship indicates that the N-4-methoxybenzyl group appears crucial for potent activity. In addition, the presence of a 6-phenyl moiety is important and the best activity is reached with a 3,4,5-trimethoxy substituent. The most active compound, bearing both the structural features, was able to inhibit tumor cell proliferation at nanomolar concentrations when tested against the full NCI human tumor cell line panel. Interestingly, this compound was effective in reducing in vitro and in vivo cell growth, impairing cell cycle progression and inducing apoptosis, as a consequence of the inhibition of tubulin polymerization, in experimental models of diffuse malignant peritoneal mesothelioma (DMPM), a rapidly lethal disease, poorly responsive to conventional therapeutic strategies.
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Affiliation(s)
- Virginia Spanò
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Università degli Studi di Palermo , Via Archirafi 32, 90123 Palermo, Italy
| | - Marzia Pennati
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale Tumori , Via Amadeo 42, 20133 Milano, Italy
| | - Barbara Parrino
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Università degli Studi di Palermo , Via Archirafi 32, 90123 Palermo, Italy
| | - Anna Carbone
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Università degli Studi di Palermo , Via Archirafi 32, 90123 Palermo, Italy
| | - Alessandra Montalbano
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Università degli Studi di Palermo , Via Archirafi 32, 90123 Palermo, Italy
| | - Vincenzo Cilibrasi
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Università degli Studi di Palermo , Via Archirafi 32, 90123 Palermo, Italy
| | - Valentina Zuco
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale Tumori , Via Amadeo 42, 20133 Milano, Italy
| | - Alessia Lopergolo
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale Tumori , Via Amadeo 42, 20133 Milano, Italy
| | - Denis Cominetti
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale Tumori , Via Amadeo 42, 20133 Milano, Italy
| | - Patrizia Diana
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Università degli Studi di Palermo , Via Archirafi 32, 90123 Palermo, Italy
| | - Girolamo Cirrincione
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Università degli Studi di Palermo , Via Archirafi 32, 90123 Palermo, Italy
| | - Paola Barraja
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Università degli Studi di Palermo , Via Archirafi 32, 90123 Palermo, Italy
| | - Nadia Zaffaroni
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale Tumori , Via Amadeo 42, 20133 Milano, Italy
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13
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Kepenekian V, Elias D, Passot G, Mery E, Goere D, Delroeux D, Quenet F, Ferron G, Pezet D, Guilloit JM, Meeus P, Pocard M, Bereder JM, Abboud K, Arvieux C, Brigand C, Marchal F, Classe JM, Lorimier G, De Chaisemartin C, Guyon F, Mariani P, Ortega-Deballon P, Isaac S, Maurice C, Gilly FN, Glehen O. Diffuse malignant peritoneal mesothelioma: Evaluation of systemic chemotherapy with comprehensive treatment through the RENAPE Database: Multi-Institutional Retrospective Study. Eur J Cancer 2016; 65:69-79. [PMID: 27472649 DOI: 10.1016/j.ejca.2016.06.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. PATIENTS AND METHODS From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). RESULTS All groups (NA: n = 42; ADJ: n = 16; PO: n = 16; NoC: n = 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P = 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P = 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07-4.94; P = 0.033). CONCLUSION This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.
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Affiliation(s)
- V Kepenekian
- Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France
| | - D Elias
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, France
| | - G Passot
- Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France
| | - E Mery
- Department of Pathology, IUCT, Toulouse, France
| | - D Goere
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, France
| | - D Delroeux
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - F Quenet
- Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Institute, Montpellier, France
| | - G Ferron
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - J M Guilloit
- Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France
| | - P Meeus
- Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France
| | - M Pocard
- Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, INSERM, U 965, Paris, France
| | - J M Bereder
- Department of General Surgery and Gastrointestinal Oncology, Archet 2 University Hospital, Nice, France
| | - K Abboud
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - C Arvieux
- Department of Digestive Surgery, Michallon University Hospital, Grenoble, France
| | - C Brigand
- Department of General Surgery, Hautepierre University Hospital, Strasbourg, France
| | - F Marchal
- Department of Surgical Oncology, Lorraine Institute of Oncology, Vandoeuvre-les-Nancy, France
| | - J M Classe
- Department of Surgical Oncology, René Gauducheau Integrated Center of Oncology, Nantes, France
| | - G Lorimier
- Department of Surgical Oncology, Paul Papin Integrated Center of Oncology, Angers, France
| | - C De Chaisemartin
- Department of Surgical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - F Guyon
- Department of Surgical Oncology, Bergonie Institute, Bordeaux, France
| | - P Mariani
- Department of Surgical Oncology, Curie Institute, Paris, France
| | - P Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - S Isaac
- Department of Pathology, Lyon-Sud University Hospital, Lyon, France
| | - C Maurice
- Clinical Research Unit, Pôle IMER (Information Médicale Evaluation et Recherche), Hospices Civils de Lyon, Lyon, France
| | - F N Gilly
- Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France
| | - O Glehen
- Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France.
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Dehal A, Smith JJ, Nash GM. Cytoreductive surgery and intraperitoneal chemotherapy: an evidence-based review-past, present and future. J Gastrointest Oncol 2016; 7:143-57. [PMID: 26941992 DOI: 10.3978/j.issn.2078-6891.2015.112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Peritoneal carcinomatosis (PC) has historically been considered a terminal condition with merely palliative treatment achieving a survival rate measured in months. Cytoreductive surgery (CyRS) and intraperitoneal chemotherapy (IPC) have emerged as potentially effective regional treatments with the potential for long-term survival in well-selected patients. The fundamentals of CyRS and IPC are patient selection and complete cytoreduction. Since there is now sufficient evidence for the superiority of CyRS and IPC to systemic chemotherapy alone in a highly select group of patients, surgeons and oncologists should be aware of this modality as a potential benefit for patients with PC. The aim of this report is to highlight cancer-specific evidence in the context of ongoing studies regarding the outcome of this treatment.
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Affiliation(s)
- Ahmed Dehal
- 1 Kaiser Permanente, Fontana, CA, USA ; 2 Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- 1 Kaiser Permanente, Fontana, CA, USA ; 2 Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- 1 Kaiser Permanente, Fontana, CA, USA ; 2 Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Mogal H, Chouliaras K, Levine EA, Shen P, Votanopoulos KI. Repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: review of indications and outcomes. J Gastrointest Oncol 2016; 7:129-42. [PMID: 26941991 DOI: 10.3978/j.issn.2078-6891.2015.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment option in selected patients with peritoneal dissemination from a variety of epithelial primaries. Even though a small proportion will be alive and potentially cured at 10 years, the majority will eventually develop recurrent disease. Repeat CRS/HIPEC is a valid consideration in a selected subpopulation of patients with isolated peritoneal recurrence. This review summarizes the data on patient selection, feasibility, limitations and outcomes of repeat CRS/HIPEC.
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Affiliation(s)
- Harveshp Mogal
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Konstantinos Chouliaras
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Perry Shen
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
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16
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CpG-oligodeoxynucleotides exert remarkable antitumor activity against diffuse malignant peritoneal mesothelioma orthotopic xenografts. J Transl Med 2016; 14:25. [PMID: 26810896 PMCID: PMC4727408 DOI: 10.1186/s12967-016-0781-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/11/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and locally aggressive disease. DMPM prognosis is dismal, mainly due to the lack of effective treatment options and the development of new therapeutic strategies is urgently needed. In this context, novel immunotherapy approaches can be explored in an attempt to improve DMPM patients' survival. METHODS We tested the efficacy of CpG-oligodeoxynucleotides (CpG-ODN), synthetic DNA sequences recognized by Toll-like receptor 9 and able to induce innate/adaptive immune response, in two DMPM orthotopic xenografts (MesoII and STO), which properly recapitulate the dissemination pattern of the disease in the peritoneal cavity. Severe combined immunodeficiency mice carrying DMPM xenografts were treated at different stages of tumor development with i.p. delivered CpG-ODN1826 for 4 weeks. CpG-ODN1826-induced modulation in the composition of peritoneal immune infiltrate was assessed by flow cytometry. RESULTS When administered to early-stage tumors (i.e., 4 days after i.p. DMPM cell injection in mice), the agent exhibited impressive efficacy against MesoII by completely inhibiting tumor take and ascites development (no evidence of tumor masses and ascites in 6/6 mice at necropsy), and also impaired STO tumor take and growth (4/6 tumor-free mice; i.p. tumor masses reduced by 94 % in the 2 remaining mice, P = 0.00005). Interestingly, when tested against late-stage STO tumors (i.e., 11 days after i.p. DMPM cell injection in mice), CpG-ODN1826 was still able to reduce the growth of i.p. tumor masses by 66 % (P = 0.0009). Peritoneal washings of tumor-bearing mice revealed a strong increase of macrophage infiltration together with a decrease in the presence of B-1 cells and a reduced IgM concentration after CpG-ODN1826 treatment. CONCLUSIONS Our results indicate that locally administered CpG-ODN1826 is able to markedly affect the growth of both early- and late-stage DMPM orthotopic xenografts in the absence of severe side effects, and suggest a possible clinical role for the agent in the therapy of DMPM.
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17
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Aydin N, Sardi A, Milovanov V, Nieroda C, Sittig M, Nunez MF, Jimenez W, Gushchin V. Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Experience of a Peritoneal Surface Malignancy Center. Am Surg 2015. [DOI: 10.1177/000313481508101228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon malignancy, which can be difficult to treat. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have evolved as the treatment of choice when complete cytoreduction is to be achieved. This study reports the outcomes of CRS/HIPEC for peritoneal mesothelioma performed in a center for peritoneal surface malignancy. A retrospective analysis of a prospective database of 389 CRS/ HIPEC procedures identified 23 patients who underwent CRS/HIPEC for DMPM from 1999 to 2014. Gender, age at diagnosis, age at surgery, previous surgeries, follow-up time, peritoneal cancer index (PCI) score, completeness of cytoreduction (CC), pathology, and overall survival (OS) were analyzed. The univariate analysis was used to determine the prognostic value of age, gender, neoadjuvant chemotherapy, histopathology of the tumor, PCI, CC, and lymph node status on survival. Mean follow-up time from surgery was 31 months (range = 0.5–124). The median PCI score was 28, and 77 per cent had PCI ≥20. CC 0–1 was achieved in 65 per cent of cases. One- and 5-year actuarial OS rates from diagnosis were 86 per cent and 60 per cent, respectively. One- and 5-year actuarial OS from HIPEC was 70 per cent and 64 per cent, respectively. The univariate analysis showed that the CC was the only significant prognostic factor. Patients with DMPM may achieve long-term survival when treated with CRS/HIPEC. The CC is the most significant prognostic factor for long-term survival.
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Affiliation(s)
- Nail Aydin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Armando Sardi
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Vladimir Milovanov
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Carol Nieroda
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Michelle Sittig
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Maria F. Nunez
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - William Jimenez
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Vadim Gushchin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
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18
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Sammartino P, Biacchi D, Cornali T, Accarpio F, Sibio S, Luraschi B, Impagnatiello A, Di Giorgio A. Computerized System for Staging Peritoneal Surface Malignancies. Ann Surg Oncol 2015; 23:1454-60. [PMID: 26564242 PMCID: PMC4819745 DOI: 10.1245/s10434-015-4966-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 11/22/2022]
Abstract
Background Peritoneal surface malignancies (PSMs) are usually staged using Sugarbaker’s Peritoneal Cancer Index (PCI) and completeness of cytoreduction score (CC-s). Although these staging tools are essential for selecting patients and evaluating outcome after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), both scoring models lack some anatomic information, thus making staging laborious and unreliable. Maintaining Sugarbaker’s original concepts, we therefore developed a computerized digital tool, including a new anatomic scheme for calculating PCI and CC-s corresponding closely to patients’ real anatomy. Our new anatomic model belongs in a web-based application known as the PSM Staging System, which contains essential clinical and pathological data for the various PSMs currently treated. Methods The new digital tool for staging PSM runs on a personal computer or tablet and comprises male and female colored anatomic models for the 13 endoabdominal regions, with borders defined according to real anatomic landmarks. A drag-and-drop tool allows users to compute the PCI and CC-s, making it easier to localize and quantify disease at diagnosis and throughout treatment, and residual disease after CRS. Conclusions Once tested online by registered users, our computerized application should provide a modern, shareable, comprehensive, user-friendly PSM staging system. Its anatomic features, along with the drag-and-drop tool, promise to make it easier to compare preoperative and postoperative PCIs, thus improving the criteria for selecting patients to undergo CRS plus HIPEC. By specifying the size, site, and number of residual lesions after CRS plus HIPEC, our digital tool should help stratify patients into outcome classes. Electronic supplementary material The online version of this article (doi:10.1245/s10434-015-4966-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paolo Sammartino
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy.
| | - Daniele Biacchi
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Tommaso Cornali
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Fabio Accarpio
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Simone Sibio
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Bernard Luraschi
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | | | - Angelo Di Giorgio
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
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19
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Huang Y, Alzahrani NA, Liauw W, Morris DL. Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma. Eur J Surg Oncol 2015; 41:1373-8. [PMID: 26227745 DOI: 10.1016/j.ejso.2015.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/10/2015] [Accepted: 07/07/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown to improve survival outcomes for patients with diffuse malignant peritoneal mesothelioma (DMPM). PATIENTS AND METHODS This is a retrospective study of prospectively collected data of 44 consecutive patients with DMPM who underwent CRS and HIPEC by the same surgical team at St George Hospital in Sydney, Australia. A total of 58 operations were performed. Clinical data were divided according to the number of operation and HIPEC the patient had undergone (Group 1 = initial CRS and HIPEC; Group 2 = 2nd CRS and HIPEC; Group 3 included 3rd CRS and HIPEC; Group 4 = 4th CRS and HIPEC). A significant difference was defined as p < 0.05. RESULTS There were no significant differences in mortality and morbidity results among the four groups. The median survival for those who only had one operation was 22 months (95% confidence interval (CI) = 0-47.2), whereas the median survival for those who had a second operation was 62 months (95% CI = 22.9-101.1). However, such a difference did not translate into a statistical significance (p = 0.141). CONCLUSION We report an encouraging median survival of 62 months in patients who had recurrence of disease and had repeat CRS and HIPEC with similar morbidity and mortality with the initial operation. Due to the learning curve of this technique, patients with recurrent mesothelioma should be referred to specialised tertiary care centres for evaluation. Selected patients may experience prolonged survival after repeat CRS and HIPEC.
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Affiliation(s)
- Y Huang
- St George Clinical School, University of New South Wales, New South Wales, Australia
| | - N A Alzahrani
- Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia; College of Medicine, Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - W Liauw
- Department of Medical Oncology, University of New South Wales, St George Hospital, Sydney, New South Wales, Australia
| | - D L Morris
- Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia.
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De Cesare M, Cominetti D, Doldi V, Lopergolo A, Deraco M, Gandellini P, Friedlander S, Landesman Y, Kauffman MG, Shacham S, Pennati M, Zaffaroni N. Anti-tumor activity of selective inhibitors of XPO1/CRM1-mediated nuclear export in diffuse malignant peritoneal mesothelioma: the role of survivin. Oncotarget 2015; 6:13119-32. [PMID: 25948791 PMCID: PMC4537003 DOI: 10.18632/oncotarget.3761] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/06/2015] [Indexed: 11/25/2022] Open
Abstract
Survivin, which is highly expressed and promotes cell survival in diffuse malignant peritoneal mesothelioma (DMPM), exclusively relies on exportin 1 (XPO1/CRM1) to be shuttled into the cytoplasm and perform its anti-apoptotic function. Here, we explored the efficacy of Selective Inhibitors of Nuclear Export (SINE), KPT-251, KPT-276 and the orally available, clinical stage KPT-330 (selinexor), in DMPM preclinical models. Exposure to SINE induced dose-dependent inhibition of cell growth, cell cycle arrest at G1-phase and caspase-dependent apoptosis, which were consequent to a decrease of XPO1/CRM1 protein levels and the concomitant nuclear accumulation of its cargo proteins p53 and CDKN1a. Cell exposure to SINE led to a time-dependent reduction of cytoplasmic survivin levels. In addition, after an initial accumulation, the nuclear protein abundance progressively decreased, as a consequence of an enhanced ubiquitination and proteasome-dependent degradation. SINE and the survivin inhibitor YM155 synergistically cooperated in reducing DMPM cell proliferation. Most importantly, orally administered SINE caused a significant anti-tumor effect in subcutaneous and orthotopic DMPM xenografts without appreciable toxicity. Overall, we have demonstrated a marked efficacy of SINE in DMPM preclinical models that may relay on the interference with survivin intracellular distribution and function. Our study suggests SINE-mediated XPO1/CRM1 inhibition as a novel therapeutic option for DMPM.
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Affiliation(s)
- Michelandrea De Cesare
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Denis Cominetti
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Valentina Doldi
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessia Lopergolo
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paolo Gandellini
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | - Marzia Pennati
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nadia Zaffaroni
- Molecular Pharmacology Unit, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Ba M, Long H, Zhang X, Tang Y, Wu Y, Yu F, Wang S, Cui S. Different sequential approaches of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treating ovarian cancer with malignant ascites. J Cancer Res Clin Oncol 2014; 140:1497-506. [DOI: 10.1007/s00432-014-1692-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/19/2014] [Indexed: 02/08/2023]
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22
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Intensive care unit admission after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Is it necessary? JOURNAL OF ONCOLOGY 2014; 2014:307317. [PMID: 24864143 PMCID: PMC4016883 DOI: 10.1155/2014/307317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/29/2014] [Accepted: 03/03/2014] [Indexed: 12/25/2022]
Abstract
Introduction. Cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a new approach for peritoneal carcinomatosis. However, high rates of complications are associated with CS and HIPEC due to treatment complexity; that is why some patients need stabilization and surveillance for complications in the intensive care unit. Objective. This study analyzed that ICU stay is necessary after HIPEC. Methods. 39 patients with peritoneal carcinomatosis were treated according to strict selection criteria with CS and HIPEC, with closed technique, and the chemotherapy administered were cisplatin 25 mg/m(2)/L and mitomycin C 3.3 mg/m(2)/L for 90-minutes at 40.5°C. Results. 26 (67%) of the 39 patients were transferred to the ICU. Major postoperative complications were seen in 14/26 patients (53%). The mean time on surgical procedures was 7.06 hours (range 5-9 hours). The mean blood loss was 939 ml (range 100-3700 ml). The mean time stay in the ICU was 2.7 days. Conclusion. CS with HIPEC for the treatment of PC results in low mortality and high morbidity. Therefore, ICU stay directly following HIPEC should not be standardized, but should preferably be based on the extent or resections performed and individual patient characteristics and risk factors. Late complications were comparable to those reported after large abdominal surgery without HIPEC.
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23
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Carbone A, Pennati M, Parrino B, Lopergolo A, Barraja P, Montalbano A, Spanò V, Sbarra S, Doldi V, De Cesare M, Cirrincione G, Diana P, Zaffaroni N. Novel 1H-pyrrolo[2,3-b]pyridine derivative nortopsentin analogues: synthesis and antitumor activity in peritoneal mesothelioma experimental models. J Med Chem 2013; 56:7060-72. [PMID: 23919303 DOI: 10.1021/jm400842x] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this study, we describe the synthesis of new nortopsentin analogues, 1H-pyrrolo[2,3-b]pyridine derivatives and their biological effects in experimental models of diffuse malignant peritoneal mesothelioma (DMPM), a rare and rapidly fatal disease, poorly responsive to conventional therapies. The three most active compounds, 1f (3-[2-(5-fluoro-1-methyl-1H-indol-3-yl)-1,3-thiazol-4-yl]-1H-pyrrolo[2,3-b]pyridine), 3f (3-[2-(1H-indol-3-yl)-1,3-thiazol-4-yl]-1-methyl-1H-pyrrolo[2,3-b]pyridine), and 1l (3-[2-(5-fluoro-1-methyl-1H-indol-3-yl)-1,3-thiazol-4-yl]-1-methyl-1H-pyrrolo[2,3-b] pyridine), which were shown to act as cyclin-dependent kinase 1 inhibitors, consistently reduced DMPM cell proliferation and induced a caspase-dependent apoptotic response, with a concomitant reduction of the expression of the active Thr(34)-phosphorylated form of the antiapoptotic protein survivin. Moreover, the combined treatment of DMPM cells with 3f derivative and paclitaxel produced a synergistic cytotoxic effect, which was paralleled by an enhanced apoptotic response. In the mouse model, i.p. administration of 1f, 3f, and 1l derivatives was effective, resulting in a significant tumor volume inhibition of DMPM xenografts (range, 58-75%) at well-tolerated doses, and two complete responses were observed in each treatment group.
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Affiliation(s)
- Anna Carbone
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF), Università degli Studi di Palermo , Via Archirafi 32, 90123 Palermo, Italy
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Hommell-Fontaine J, Isaac S, Passot G, Decullier E, Traverse-Glehen A, Cotte E, You B, Mohamed F, Gilly FN, Glehen O, Berger F. Malignant peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is GLUT1 expression a major prognostic factor? A preliminary study. Ann Surg Oncol 2013; 20:3892-8. [PMID: 23800898 DOI: 10.1245/s10434-013-3077-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Indexed: 01/14/2023]
Abstract
PURPOSE Diffuse malignant peritoneal mesothelioma (DMPM) is a rare primary peritoneal malignancy. Its prognosis has been improved by an aggressive locoregional treatment combining extensive cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Prognostic factors are currently poorly defined for this disease but are essential if treatment is to be standardized. METHODS Twenty-eight patients with DMPM, who were considered preoperatively to be candidates for CRS and HIPEC between June 1998 and August 2010 at our institution, were selected for this study. Medical records and histopathological features were retrospectively reviewed and 24 clinical, histological, and immunohistochemical parameters were assessed for their association with overall survival by univariate and multivariate analyses. RESULTS The following factors were significantly associated with overall survival by univariate analysis: predominant histological growth pattern in the epithelioid areas, nuclear grooves in the epithelioid areas, atypical mitoses, and calretinin and GLUT1 expression by immunohistochemistry in the epithelioid areas. Expression of the facilitative glucose transporter protein GLUT1 in the epithelioid areas was the only factor independently associated with overall survival by multivariate analysis. CONCLUSIONS GLUT1 expression appears to be an indicator of poor prognosis in DMPM. Standard histological classification of DMPM may not be adequate to select patients for aggressive locoregional treatments, such as CRS and HIPEC. Multicenter validation of the prognostic factors identified in this preliminary study is needed to refine patient selection for potential cure.
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Affiliation(s)
- J Hommell-Fontaine
- Service de Chirurgie Générale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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Van der Speeten K, Anthony Stuart O, Sugarbaker PH. Pharmacology of Perioperative Intraperitoneal and Intravenous Chemotherapy in Patients with Peritoneal Surface Malignancy. Surg Oncol Clin N Am 2012; 21:577-97. [DOI: 10.1016/j.soc.2012.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Adjuvant bidirectional chemotherapy with intraperitoneal pemetrexed combined with intravenous Cisplatin for diffuse malignant peritoneal mesothelioma. Gastroenterol Res Pract 2012; 2012:890450. [PMID: 22927839 PMCID: PMC3423889 DOI: 10.1155/2012/890450] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/22/2012] [Indexed: 12/12/2022] Open
Abstract
Cytoreductive surgery (CRS) with heated intraoperative intraperitoneal chemotherapy (HIPEC) has emerged as optimal treatment for diffuse malignant peritoneal mesothelioma (DMPM) showing median survivals of 36–92 months. However, recurrences occur frequently even in patients undergoing optimal cytreduction and are often confined to the abdomen.
We initiated a Phase II study of adjuvant intraperitoneal pemetrexed combined with intravenous cisplatin for patients undergoing CRS and HIPEC for DMPM.
The treatment consisted of pemetrexed 500 mg/m2 intraperitoneally and cisplatin 50 mg/m2 intravenously given simultaneously on day 1 of every 21 day cycle for 6 cycles. The primary endpoint of the study was treatment related toxicity.
From July 2007 until July 2009 ten patients were enrolled. Nine of 10 completed all 6 cycles of adjuvant treatment per protocol. The most common toxicities were fatigue, nausea and abdominal pain grade 1 or 2. There was one grade 3 toxicity consisting of a catheter infection. The median survival for all 10 patients was 33.5 months. Pharmacokinetic analysis of intraperitoneal pemetrexed showed a peritoneal to plasma area under the curve ratio of 70.
Our study shows that adjuvant intravenous cisplatin and intraperitoneal pemetrexed can be used following CRS and HIPEC for DMPM with low morbidity.
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Hyperthermic intraperitoneal chemotherapy with melphalan: a summary of clinical and pharmacological data in 34 patients. Gastroenterol Res Pract 2012; 2012:827534. [PMID: 22811702 PMCID: PMC3395133 DOI: 10.1155/2012/827534] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 05/01/2012] [Indexed: 11/18/2022] Open
Abstract
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment option for peritoneal metastases. The optimal agents for HIPEC have not been established. Melphalan is a drug with broad activity and a favorable profile for intraperitoneal application. The purpose of this study is to review our experience using melphalan for HIPEC. Pharmacologic data was obtained. Thirty four patients who underwent CRS for peritoneal metastases received melphalan for HIPEC between 2003 and 2011. The first 10 patients received 70 mg/m2; subsequent 24 received 60 or 70 mg/m2. The mean PCI was 21 ± 7. Twenty-eight patients (83%) had a CC score of 1 or 2. The mean length of stay was 18 ± 2 days. Nine patients (26%) had a grade 3 and 6 (17%) had grade 4 morbidity. There were no postoperative deaths. The pharmacologic analysis of plasma to peritoneal fluid levels of melphalan showed an AUC ratio of 33 while the tumor nodules to peritoneal ratio was 8. Melphalan is an acceptable agent for use in HIPEC. The morbidity of intraperitoneal melphalan at the dose of 60–70 mg/m2 appears acceptable. Further studies comparing the effectiveness of melphalan and other HIPEC agents are needed.
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Schulz MD, Zubris KAV, Wade JE, Padera RF, Xu X, Grinstaff MW, Colson YL. Paclitaxel-Loaded Expansile Nanoparticles in a Multimodal Treatment Model of Malignant Mesothelioma. Ann Thorac Surg 2011; 92:2007-13; discussion 2013-4. [DOI: 10.1016/j.athoracsur.2011.04.106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 04/04/2011] [Accepted: 04/07/2011] [Indexed: 02/07/2023]
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Sugarbaker PH, Van der Speeten K, Anthony Stuart O, Chang D. Impact of surgical and clinical factors on the pharmacology of intraperitoneal doxorubicin in 145 patients with peritoneal carcinomatosis. Eur J Surg Oncol 2011; 37:719-26. [PMID: 21621952 DOI: 10.1016/j.ejso.2011.04.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/21/2011] [Accepted: 04/19/2011] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a combined treatment modality considered for selected patients with peritoneal carcinomatosis from colorectal and appendiceal cancer. Doxorubicin is a drug consistently used by our group in this clinical setting. The surgical and clinical factors that modify the pharmacokinetics of HIPEC may be important for the design of future perioperative chemotherapy regimens. MATERIALS AND METHODS The patients included were 145 who had colorectal or appendiceal carcinomatosis resected using CRS prior to treatment with HIPEC with doxorubicin as part of a multidrug regimen. The effect of clinical and surgical factors on drug distribution after a single intraperitoneal bolus administration with doxorubicin was determined. RESULTS The pharmacokinetics of 145 patients treated with intraperitoneal doxorubicin showed a 78 times greater exposure to peritoneal surfaces as compared to plasma. At 90 min 12% of the drug remained in the chemotherapy solution and 88% was retained in the body. The extent of visceral resection and peritonectomy increased the clearance of doxorubicin from the peritoneal space. A major resection of visceral peritoneal surface, a contracted peritoneal space, and an incomplete cytoreduction reduced drug clearance. CONCLUSIONS Surgical and clinical factors may require modifications of chemotherapy administration. A large visceral resection and a contracted peritoneal space caused a reduced doxorubicin clearance. Total diffusion surface is an important determinant of doxorubicin pharmacokinetics.
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Affiliation(s)
- P H Sugarbaker
- Washington Cancer Institute, Washington Hospital Center, 106 Irving Street, NW, Suite 3900, Washington, DC 20010, USA.
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Mckenzie S, Artinyan A, Holt AD, Garcia-Aguilar J, Ellenhorn J, Morgan R, Paz B. Selection Criteria for Complete Cytoreduction after Cytoreductive Surgery for Peritoneal Surface Malignancy: Lessons Learned from Our First Series of Patients. Am Surg 2011. [DOI: 10.1177/000313481107700418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The appropriate selection criteria for complete cytoreduction in patients with peritoneal surface malignancies have not been determined. We performed a retrospective analysis of all patients receiving cytoreductive surgery (CRS) during the study period of 2004 to 2008 to determine appropriate selection criteria for successful complete cytoreduction. During the study period, 38 patients underwent attempted CRS. Cytoreduction was scored complete, incomplete, or not reported in 53 per cent (n = 20), 37 per cent (n = 14), and 11 per cent (n = 4), respectively. Median overall survival for compete and incomplete cytoreduction was 56 months versus 5 months ( P = 0.011), respectively. Compared with incomplete cytoreduction, patients receiving complete cytoreduction were more likely to have a lower Peritoneal Cancer Index (PCI) and not have received preoperative systemic chemotherapy (CT). Univariate analysis verified PCI greater than 20 (hazard ratio [HR], 0.048; CI, 0.004 to 0.515; P = 0.01) and CT (HR, 0.17; 0.004 to 0.77; P = 0.021) as predictors of incomplete cytoreduction. Small bowel (100%), periportal region (33%), and mesentery (27%) were the most common sites of residual disease. In conclusion, PCI less than 20 and the need for preoperative chemotherapy should be strongly considered when selecting patients with peritoneal surface malignancy for attempted cytoreduction. Early evaluation of the small bowel, mesentery, and periportal region for resectability prevents unnecessary surgery.
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Affiliation(s)
- Shaun Mckenzie
- Departments of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California
| | - Avo Artinyan
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Alicia D. Holt
- Departments of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California
| | - Julio Garcia-Aguilar
- Departments of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California
| | - Joshua Ellenhorn
- Departments of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California
| | - Robert Morgan
- Departments of Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Benjamin Paz
- Departments of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California
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Van der Speeten K, Stuart OA, Chang D, Mahteme H, Sugarbaker PH. Changes induced by surgical and clinical factors in the pharmacology of intraperitoneal mitomycin C in 145 patients with peritoneal carcinomatosis. Cancer Chemother Pharmacol 2010; 68:147-56. [PMID: 20857115 DOI: 10.1007/s00280-010-1460-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 09/01/2010] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are a combined treatment modality considered for selected patients with peritoneal carcinomatosis from colorectal and appendiceal cancer. Mitomycin C is a drug often used in this clinical setting. The surgical and clinical factors that may influence the pharmacokinetics of hyperthermic intraperitoneal chemotherapy should be further elucidated. MATERIALS AND METHODS The patients included were 145 who had colorectal or appendiceal carcinomatosis resected using cytoreductive surgery prior to treatment with hyperthermic intraperitoneal chemotherapy with mitomycin C as part of a multidrug regimen. The effect of clinical and surgical factors on drug distribution after single intraperitoneal bolus administration with mitomycin C was determined. RESULTS The pharmacokinetics of 145 patients treated with intraperitoneal mitomycin C showed a 27 times greater exposure to peritoneal surfaces when compared to plasma. At 90 min, 29% of the drug remained in the chemotherapy solution, 62% was retained in the body, and 9% was excreted in the urine. The extent of peritonectomy increased the clearance of mitomycin C from the peritoneal space (p = 0.051). A major resection of visceral peritoneal surface and a contracted peritoneal space reduced drug clearance. A contracted peritoneal space significantly reduced (p = 0.0001) drug concentrations in the plasma. CONCLUSIONS Surgical and clinical factors may require modifications of drug dose or timing of chemotherapy administration. A large visceral resection and a contracted peritoneal space caused a reduced mitomycin C clearance. Total diffusion surface is an important determinant of mitomycin C pharmacokinetics.
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Receptor tyrosine kinase and downstream signalling analysis in diffuse malignant peritoneal mesothelioma. Eur J Cancer 2010; 46:2837-48. [PMID: 20692828 DOI: 10.1016/j.ejca.2010.06.130] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/22/2010] [Accepted: 06/24/2010] [Indexed: 11/22/2022]
Abstract
Our aim was to assess the activation profile of EGFR, PDGFRB and PDGFRA receptor tyrosine kinases (RTK) and their downstream effectors in a series of cryopreserved diffuse malignant peritoneal mesothelioma (DMPM) surgical specimens to discover the targets for drug inhibition. We also made a complementary analysis of the cytotoxic effects of some kinase inhibitors on the proliferation of the human peritoneal mesothelioma STO cell line. We found the expression/phosphorylation of EGFR and PDGFRB in most of the tumours, and PDGFRA activation in half. The expression of the cognate ligands TGF-α, PDGFB and PDGFA in the absence of RTK mutation and amplification suggested the presence of an autocrine/paracrine loop. There was also evidence of EGFR and PDGFRB co-activation. RTK downstream signalling analysis demonstrated the activation/expression of ERK1/2, AKT and mTOR, together with S6 and 4EBP1, in almost all the DMPMs. No KRAS/BRAF mutations, PI3KCA mutations/amplifications or PTEN inactivation were observed. Real-time polymerase chain reaction revealed the decreased expression of TSC1 c-DNA in half of the tumours. In vitro cytotoxicity studies showed the STO cell line to be resistant to gefitinib and sensitive to sequential treatment with RAD001 and sorafenib; these findings were consistent with the presence of the KRAS mutation G12D in these cells although it was not detectable in the original tumour. Our results highlight the ligand-dependent activation and co-activation of EGFR and PDGFRB, as well as a connection between these activated RTKs and the downstream mTOR pathway, thus supporting the role of combined treatment with RTK and mTOR inhibitors in DMPM.
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Balestra MR, Baratti D, Crippa F, Laterza B, Kusamura S, Langer M, Deraco M. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in a Patient with Peritoneal Mesothelioma and HIV Infection. TUMORI JOURNAL 2010; 96:340-4. [DOI: 10.1177/030089161009600226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background High rates of septic complications have been associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, which has been suggested as the treatment of choice for isolated peritoneal malignancies. Patients infected by the human immunodeficiency virus (HIV) are still considered at a high operative risk. Method A 58-year-old man with HIV infection and diffuse peritoneal mesothelioma underwent optimal cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Results The patient experienced a complete clinical response to therapy with no adverse effect on disease course or markers for HIV (CD4 count, beta2-microglobulin, neopterin, p24 antigen, and viral load). Conclusion This report suggests that this innovative approach can be successfully performed also in this clinical setting. In selected patients who respond to all criteria, surgery is possible and is a safe and effective therapeutic option.
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Affiliation(s)
- Maria Rosaria Balestra
- Department of Surgery, National Cancer Institute, Milan
- Department of Surgery, University G. d'Annunzio, Chieti
| | - Dario Baratti
- Department of Surgery, National Cancer Institute, Milan
| | - Fulvio Crippa
- Clinic of Infectious Diseases, San Raffaele Hospital, Milan
| | | | | | - Martin Langer
- Department of Anesthesiology, National Cancer Institute, Milan, Italy
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Deraco M, Baratti D, Cabras AD, Zaffaroni N, Perrone F, Villa R, Jocollè J, Balestra MR, Kusamura S, Laterza B, Pilotti S. Experience with peritoneal mesothelioma at the Milan National Cancer Institute. World J Gastrointest Oncol 2010; 2:76-84. [PMID: 21160925 PMCID: PMC2999160 DOI: 10.4251/wjgo.v2.i2.76] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/06/2009] [Accepted: 11/13/2009] [Indexed: 02/05/2023] Open
Abstract
Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon and rapidly fatal tumor. Therapeutic options have traditionally been limited and ineffective. The biologic and molecular events correlated with poor responsiveness to therapy are still poorly understood. In recent years, an innovative treatment approach involving aggressive cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy has reportedly resulted in improved outcome, as compared to historical controls. Since 1995, at the National Cancer Institute (NCI) of Milan (Italy), patients with DMPM have been treated with CRS and hyperthermic intra-peritoneal chemotherapy (HIPEC). In the present paper, clinical experiences and basic science investigations on DMPM at Milan NCI are reviewed. Peri-operative and long-term outcome results with CRS and HIPEC are presented. Clinico-pathological prognostic factors were investigated by multivariate analysis. The pathologic features and immunohistochemical markers related to DMPM biologic behavior were assessed in a large case-series uniformly treated at our institution. The prevalence and prognostic role of telomere maintenance mechanisms, which account for the limitless cell replicative potential of many malignancies, were studied. The dysregulation of the apoptotic pathways may play a role in the relative chemo-resistance of DMPM and a better understanding of apoptosis-related mechanisms could result in novel targeted therapeutic strategies. On this basis, the expression of survivin and other IAP family members (IAP-1, IAP-2, and X-IAP), the pro-apoptotic protein Smac/DIABLO, and antigens associated with cell proliferation (Ki-67) and apoptosis (caspase-cleaved cytokeratin-18) were analyzed. Finally, analyses of EGFR, PDGFRA and PDGFRB were performed to ascertain if deregulation of RTK could offer useful alternative therapeutic targets.
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Affiliation(s)
- Marcello Deraco
- Marcello Deraco, Dario Baratti, Maria Rosaria Balestra, Shigeki Kusamura, Barbara Laterza, Department of Surgery, National Cancer Institute, 20133 Milan, Italy
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Baratti D, Kusamura S, Laterza B, Balestra MR, Deraco M. Early and long-term postoperative management following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World J Gastrointest Oncol 2010; 2:36-43. [PMID: 21160815 PMCID: PMC2999156 DOI: 10.4251/wjgo.v2.i1.36] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 08/31/2009] [Accepted: 09/07/2009] [Indexed: 02/05/2023] Open
Abstract
Peritoneal surface malignancies have been traditionally regarded as end-stage conditions amenable to merely palliative options. The combination of aggressive cytoreductive surgery (CRS), involving peritonectomy procedures and multivisceral resections, with intra-operative hyperthermic intra-peritoneal chemotherapy (HIPEC) and/or early postoperative intra-peritoneal chemotherapy (EPIC) to treat the microscopic residual tumor is a new concept. In recent years, promising results have been reported for peritoneal mesothelioma and carcinomatosis of gastrointestinal and gynaecologic origin treated by this combined protocol. However, CRS with HIPEC and/or EPIC is a complex procedure associated with high rates of potentially life-threatening complications. Furthermore, disease progression following comprehensive treatment is not uncommon and represents a relevant cause of treatment failure. The present paper reviews the available information on early postoperative management and long-term follow-up in patients treated with CRS and intraperitoneal chemotherapy. The peculiar clinical and biological alterations that can be expected during an uncomplicated postoperative course, as compared to standard digestive surgery, are discussed. Early recognition and appropriate management of the most common adverse events are addressed, in order to minimize the impact of treatment-related morbidity on survival and quality of life results. Since re-operative surgery with additional HIPEC, has proven to be useful in selected patients with recurrent disease, long-term surveillance aiming at early detection of postoperative disease progression has become a relevant issue. Current results on follow-up investigations are presented.
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Affiliation(s)
- Dario Baratti
- Dario Baratti, Shigeki Kusamura, Barbara Laterza, Maria Rosaria Balestra, Marcello Deraco, Department of Surgery, National Cancer Institute, Via Venezian 1, 20133 Milan, Italy
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