Cytoreductive Surgery and HIPEC for Malignant Peritoneal Mesothelioma: Outcomes and Survival From an Australian Centre

Shamavonian, Raphael; Cheng, Ernest; Karpes, Josh; Barat, Shoma; Ahmadi, Nima; Morris, David L.

doi:10.21873/anticanres.15776

Cited by 8 publications

(2 citation statements)

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“…Four patients had a major morbidity (defined as Clavien-Dindo III or above), and there was one mortality after fourteen days. The same unit published updated data in 2022 on 81 patients treated for MPM from 1999 to 2021, reporting that morbidity and mortality remained acceptable at 43.2 percent and under five percent, respectively [76]. These numbers are similar to those published by Yan et al in a systematic review of seven studies from six specialist CRS centres, reporting a range of morbidity from 25 to 40 percent, and a range for mortality from zero to eight percent [77].…”

Section: Morbidity and Mortalitysupporting

confidence: 55%

Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions

Karpes,

Shamavonian,

Dewhurst

et al. 2023

Cancers

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Malignant peritoneal mesothelioma (MPM) is an extremely rare malignancy usually confined to the abdominal cavity. With an aggressive natural history, morbidity and mortality are consequences of progressive locoregional effects within the peritoneal cavity. The first reported case was in the early 20th century, however, due to the rare nature of the disease and a large gap in understanding of the clinicopathological effects, the next reported MPM cases were only published half a decade later. Since then, there has been exponential growth in our understanding of the disease, however, there are no prospective data and a paucity of literature regarding management. Traditionally, patients were treated with systemic therapy and the outcomes were very poor, with a median survival of less than one year. However, with the advent of cytoreductive surgery and locoregional chemotherapy, there have been significant improvements in survival. Even more recently, with an improved understanding of the molecular pathogenesis of MPM, there have been reports of improved outcomes with novel therapies. Given the disastrous natural history of MPM, the limited data, and the lack of universal treatment guidelines, an in-depth review of the past, present, and future of MPM is critical to improve treatment regimens and, subsequently, patient outcomes.

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Section: Morbidity and Mortalitysupporting

confidence: 55%

Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions

Karpes,

Shamavonian,

Dewhurst

et al. 2023

Cancers

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“…Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can improve the prognosis for selected patients, resulting in a median overall survival (OS) ranging from 19 to 92 months. [1][2][3][4] Nonetheless, even after complete cytoreduction, recurrence rates are high. Perioperative systemic chemotherapy has shown no survival benefit for patients with MPM.…”

Section: What This Study Addsmentioning

confidence: 99%

Adjuvant dendritic cell-based immunotherapy after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with malignant peritoneal mesothelioma: a phase II clinical trial

Dietz

Quintelier

Kooten

et al. 2023

J Immunother Cancer

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BackgroundMalignant peritoneal mesothelioma (MPM) is an aggressive malignancy with a poor prognosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival outcomes, but recurrence rates remain high. Dendritic cell-based immunotherapy (DCBI) showed promising results in patients with pleural mesothelioma. The primary aim of this trial was to determine feasibility of adjuvant DCBI after CRS-HIPEC.MethodsThis open-label, single-center, phase II clinical trial, performed in the Erasmus MC Cancer Institute Rotterdam, the Netherlands, included patients with epithelioid MPM. 4–6 weeks before CRS-HIPEC leukapheresis was performed. 8–10 weeks after surgery, DCBI was administered three times biweekly. Feasibility was defined as administration of at least three adjuvant vaccinations in 75% of patients. Comprehensive immune cell profiling was performed on peripheral blood samples prior to and during treatment.ResultsAll patients who received CRS-HIPEC (n=16) were successfully treated with adjuvant DCBI. No severe toxicity related to DCBI was observed. Median progression-free survival (PFS) was 12 months (IQR 5–23) and median overall survival was not reached. DCBI was associated with increased proliferation of circulating natural killer cells and CD4+ T-helper (Th) cells. Co-stimulatory molecules, including ICOS, HLA-DR, and CD28 were upregulated predominantly on memory or proliferating Th-cells and minimally on CD8+ cytotoxic T-lymphocytes (CTLs) after treatment. However, an increase in CD8+ terminally differentiated effector memory (Temra) cells positively correlated with PFS, whereas co-expression of ICOS and Ki67 on CTLs trended towards a positive correlation.ConclusionsAdjuvant DCBI after CRS-HIPEC in patients with MPM was feasible and safe, and showed promising survival outcomes. DCBI had an immune modulatory effect on lymphoid cells and induced memory T-cell activation. Moreover, an increase of CD8+ Temra cells was more pronounced in patients with longer PFS. These data provide rationale for future combination treatment strategies.Trial registration numberNTR7060; Dutch Trial Register (NTR).

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Complications After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy ‐ Can We Do Better?

Alberto V.,

Zuluaga,

Winter

et al. 2024

Journal of Surgical Oncology

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The main aim of this review is to analyze postoperative complications after cytoreductive surgery and intraperitoneal chemotherapy. Although the literature in this field is ever growing, reporting on complication is not a given. Nevertheless, some main risk factors such as prior surgery, high tumor burden and the center's expertize have an impact on patient outcomes. Transparency is key, if we want to continue to improve.

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Cytoreductive Surgery and HIPEC for Malignant Peritoneal Mesothelioma: Outcomes and Survival From an Australian Centre

Cited by 8 publications

References 0 publications

Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions

Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions

Adjuvant dendritic cell-based immunotherapy after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with malignant peritoneal mesothelioma: a phase II clinical trial

Complications After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy ‐ Can We Do Better?

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