Intraoperative adjuncts for malignant pleural mesothelioma

Abstract

Malignant pleural mesothelioma (MPM) is a rapidly fatal disease. Multimodality surgically based therapies may extend survival in select patients, however, local relapse after resection is common.Novel intraoperative adjunctive therapies including heated intraoperative chemotherapy (HIOC), heated intraoperative povidone-iodine (PVP-I), and photodynamic therapy (PDT) target micrometastatic disease and aim to improve local control. This review details the most recent studies and trials of HIOC, heated intraoperative PVP-I, and PDT, this aims to provide an update on some of the most promising intraoperative adjuncts for patients with MPM.Keywords: Malignant pleural mesothelioma (MPM); heated intraoperative chemotherapy (HIOC); heated intraoperative povidone-iodine (PVP-I); photodynamic therapy (PDT)

A Clinical Trial of TumorGlow to Identify Residual Disease During Pleurectomy and Decortication

“…Current standard-of-care, consisting of palliative chemotherapy, results in median survivals less than 1 year (2, 3). In select patients with limited disease, multi-modal treatment protocols incorporating chemotherapy, radiation and cytoreduction via pleurectomy and decortication (P/D) or extrapleural pneumonectomy (EPP) have been associated with improved median survivals (2, 4). The overall goal of surgical resection is tumor cytoreduction, or complete macroscopic (R1) resection, which confers a survival advantage.…”

Polymeric films loaded with cisplatin for malignant pleural mesothelioma: a pharmacokinetic study in an ovine model

“…In fact, other systemic or intrapleural alternatives have been under investigation by different working groups (22)(23)(24)(25)(26). Immunotherapy, in the form of immune checkpoint blockade, immunotoxin therapy, anticancer vaccines, oncolytic viral therapy, and adoptive cell therapy are the most common methods of immunotherapy currently being used in the clinical setting (22).…”

“…Immunotherapy can also be associated with radiotherapy [including intensity modulated radiation therapy (IMRT)] and chemotherapy (23,24). The potential benefit of short course high dose radiation on the immune system has been reported, and that could be the rationale for the combination of the two modality treatments (23).…”

“…The potential benefit of short course high dose radiation on the immune system has been reported, and that could be the rationale for the combination of the two modality treatments (23). On the other hand, some chemotherapeutic drugs have been shown to induce cell death and therefore can stimulate an immune response against tumor cells (23)(24)(25). Some years ago, we assessed the effect of intrapleural immuno-chemotherapy on the extent of local tumor recurrence in an established rat model of MPM (6).…”

The role of intracavitary therapies in the treatment of malignant pleural mesothelioma

“…All these effects are strongly dependent on many factors related to photosensitizing agent and the modalities of its administration (24,25). PDT in the treatment of MPM carries two main advantages; firstly, the cytotoxic effects have a relatively deep penetration in to the tissues; secondly, it has no cumulative toxic effect, so that it can be therefore administered several times and it can be associated to the others traditional systemic or loco-regional treatments such as chemotherapy or radiotherapy (7,25,26).…”