Current Treatment Options in Oncology

, Volume 9, Issue 2–3, pp 180–190

Peritoneal Mesothelioma

  • Mary E. Hesdorffer
  • John Chabot
  • Carolyn DeRosa
  • Robert Taub
Malignant Mesothelioma

Opinion statement

Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm that rapidly spreads within the confines of the abdominal cavity to involve most accessible peritoneal and omental surfaces. Current treatment options are unsatisfactory, and new approaches are needed. Recent publications have reported improved survival with an intensive loco-regional treatment strategy including cytoreductive surgery (CRS) along with hyperthermic intraperitoneal chemotherapy (HIPEC). We have noted at our institution prolonged survival in selected patients after intensive multimodality treatment. Our most recently reported trial included initial laparatomy with omentectomy, resection of peritoneal implants, and placement of bilateral peritoneal Portacath; repeated courses of intraperitoneal chemotherapy with doxorubicin, cisplatin, and interferon gamma; second-look laparotomy; and intraoperative hyperthermic perfusion with mitomycin and cisplatin, followed by whole abdominal radiation. To date there have been no universally accepted treatments for MPM. Unless referred to a specialty center, patients are routinely treated with pemetrexed and cisplatin which has been shown to increase survival in pleural mesothelioma.


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References and Recommended Reading

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  1. 1.
    Price B. Analysis of current trends in united states mesothelioma incidence. Am J Epidemiol. 1997;145(3):211–218.PubMedGoogle Scholar
  2. 2.
    Yates DH, Corrin B, Stidolph PN, Browne K. Malignant mesothelioma in south east England: Clinicopathological experience of 272 cases. Thorax. 1997;52(6):507–512.PubMedCrossRefGoogle Scholar
  3. 3.
    Cocco P, Dosemeci M. Peritoneal cancer and occupational exposure to asbestos: results from the application of a job-exposure matrix. Am J Ind Med. 1999;35(1):9–14. doi:10.1002/(SICI)1097-0274(199901)35:1<9::AID-AJIM2>3.0.CO;2-VCrossRefPubMedGoogle Scholar
  4. 4.
    Browne K, Smither WJ. Asbestos-related mesothelioma: Factors discriminating between pleural and peritoneal sites. Br J Ind Med. 1983;40(2):145–152.PubMedGoogle Scholar
  5. 5.
    Rivera Z, Strianese O, Bertino P, Yang H, Pass H, Carbone M. The relationship between simian virus 40 and mesothelioma. Curr Opin Pulm Med. 2008;14(4):316–321. doi:10.1097/MCP.0b013e3283018220 CrossRefPubMedGoogle Scholar
  6. 6.
    Matanoski GM, Tonascia JA, Correa-Villasenor A, Yates KC, Fink N, Elliott E, et al.: Cancer risks and low-level radiation in U.S. shipyard workers. J Radiat Res (Tokyo) 2008, 49(1):83–91. doi:10.1269/jrr.06082 CrossRefGoogle Scholar
  7. 7.
    Gentiloni N, Febbraro S, Barone C, Lemmo G, Neri G, Zannoni G, et al. Peritoneal mesothelioma in recurrent familial peritonitis. J Clin Gastroenterol 1997;24(4):276–279. doi:10.1097/00004836-199706000-00023 CrossRefPubMedGoogle Scholar
  8. 8.
    Elias D, Bedard V, Bouzid T, Duvillard P, Kohneh-Sharhi N, Raynard B, et al. Malignant peritoneal mesothelioma: treatment with maximal cytoreductive surgery plus intraperitoneal chemotherapy. Gastroenterol Clin Biol. 2007;31(10):784–788. doi:10.1016/S0399-8320(07)73964-7 PubMedCrossRefGoogle Scholar
  9. 9.
    Nonaka D, Kusamura S, Baratti D, Casali P, Cabras AD, Younan R, et al. Diffuse malignant mesothelioma of the peritoneum: a clinicopathological study of 35 patients treated locoregionally at a single institution. Cancer. 2005;104(10):2181–2188. doi:10.1002/cncr.21239 CrossRefPubMedGoogle Scholar
  10. 10.••
    Feldman AL, Libutti SK, Pingpank JF, Bartlett DL, Beresnev TH, Mavroukakis SM, et al. Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. J Clin Oncol. 2003;21(24):4560–4567. doi:10.1200/JCO.2003.04.150 CrossRefPubMedGoogle Scholar
  11. 11.
    Vogelzang NJ. Emerging insights into the biology and therapy of malignant mesothelioma. Semin Oncol. 2002;29(6 Suppl 18):35–42. doi:10.1016/S0093-7754(02)70044-4 PubMedGoogle Scholar
  12. 12.
    Baker PM, Clement PB, Young RH. Malignant peritoneal mesothelioma in women: a study of 75 cases with emphasis on their morphologic spectrum and differential diagnosis. Am J Clin Pathol. 2005;123(5):724–737. doi:10.1309/2H0NVRERPP2LJDUA CrossRefPubMedGoogle Scholar
  13. 13.
    Trupiano JK, Geisinger KR, Willingham MC, Manders P, Zbieranski N, Case D, et al. Diffuse malignant mesothelioma of the peritoneum and pleura, analysis of markers. Mod Pathol. 2004;17(4):476–481. doi:10.1038/modpathol.3800067 CrossRefPubMedGoogle Scholar
  14. 14.
    Kannerstein M, Churg J. Peritoneal mesothelioma. Hum Pathol. 1977 ;8(1):83–94. doi:10.1016/S0046-8177(77)80067-1 CrossRefPubMedGoogle Scholar
  15. 15.
    Sebbag G, Sugarbaker PH. Peritoneal mesothelioma proposal for a staging system. Eur J Surg Oncol. 2001;27(3):223–224. doi:10.1053/ejso.2001.1044 CrossRefPubMedGoogle Scholar
  16. 16.
    Wang ZJ, Reddy GP, Gotway MB, Higgins CB, Jablons DM, Ramaswamy M, et al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics. 2004;24(1):105–119. doi:10.1148/rg.241035058 CrossRefPubMedGoogle Scholar
  17. 17.
    Busch JM, Kruskal JB, Wu B.: Armed Forces Institute of Pathology. Best cases from the AFIP malignant peritoneal mesothelioma. Radiographics 2002, 22(6):1511–1515. doi:10.1148/rg.226025125 CrossRefPubMedGoogle Scholar
  18. 18.
    Rusch VW, Godwin JD, Shuman WP. The role of computed tomography scanning in the initial assessment and the follow-up of malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 1988;96(1):171–177.PubMedGoogle Scholar
  19. 19.
    Deraco M, Nonaka D, Baratti D, Casali P, Rosai J, Younan R, et al.: Prognostic analysis of clinicopathologic factors in 49 patients with diffuse malignant peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion. Ann Surg Oncol 2006, 13(2):229–237. doi:10.1245/ASO.2006.03.045 CrossRefPubMedGoogle Scholar
  20. 20.
    Pass HI, Wali A, Tang N, Ivanova A, Ivanov S, Harbut M, et al.: Soluble mesothelin-related peptide level elevation in mesothelioma serum and pleural effusions. Ann Thorac Surg 2008, 85(1):265, 272; discussion 272Google Scholar
  21. 21.
    Vogelzang NJ. Malignant mesothelioma: diagnostic and management strategies for 1992. Semin Oncol. 1992;194(Suppl 11):64–71.PubMedGoogle Scholar
  22. 22.
    Markman M, Cleary S, Pfeifle C, Howell SB. Cisplatin administered by the intracavitary route as treatment for malignant mesothelioma. Cancer. 1986;58(1):18–21. doi:10.1002/1097-0142(19860701)58:1<18::AID-CNCR2820580105>3.0.CO;2-CCrossRefPubMedGoogle Scholar
  23. 23.
    Hesdorffer ME, Chabot JA, Keohan ML, Fountain K, Talbot S, Gabay M, et al. Combined resection, intraperitoneal chemotherapy, and whole abdominal radiation for the treatment of malignant peritoneal mesothelioma. Am J Clin Oncol. 2008; 31(1):49–54.CrossRefPubMedGoogle Scholar
  24. 24.
    Sugarbaker PH. Local-regional approach to diffuse malignant peritoneal mesothelioma. Gastroenterol Clin Biol. 2007;31(10):780–781. doi:10.1016/S0399-8320(07)73963-5 PubMedGoogle Scholar
  25. 25.
    Sugarbaker PH. Peritoneum as the first-line of defense in carcinomatosis. J Surg Oncol. 2007;95(2):93–94. doi:10.1002/jso.20676 CrossRefPubMedGoogle Scholar
  26. 26.
    Lomas DA, Wallis PJ, Stockley RA. Palliation of malignant ascites with a tenckhoff catheter. Thorax. 1989;44(10):828.CrossRefPubMedGoogle Scholar
  27. 27.
    Lederman GS, Recht A, Herman T, Osteen R, Corson J, Antman KH. Long-term survival in peritoneal mesothelioma the role of radiotherapy and combined modality treatment. Cancer 1987;59(11):1882–1886. doi:10.1002/1097-0142(19870601)59:11<1882::AID-CNCR2820591107>3.0.CO;2-0CrossRefPubMedGoogle Scholar
  28. 28.
    Takeuchi K, Fujimoto M, Tsujino T, Takeda Y, Yoshida S. Impressive remission of locally advanced malignant peritoneal mesothelioma treated with combination of radiotherapy and intraperitoneal paclitaxel. Eur J Gynaecol Oncol 2007;28(4):322–323.PubMedGoogle Scholar
  29. 29.••
    Manegold C, Symanowski J, Gatzemeier U, Reck M, von Pawel J, Kortsik C, et al. Second-line (post-study) chemotherapy received by patients treated in the phase III trial of pemetrexed plus cisplatin versus cisplatin alone in malignant pleural mesothelioma. Ann Oncol. 2005; 16(6):923–927. doi:10.1093/annonc/mdi187 CrossRefPubMedGoogle Scholar
  30. 30.••
    Janne PA, Wozniak AJ, Belani CP, Keohan ML, Ross HJ, Polikoff JA, et al. Open-label study of pemetrexed alone or in combination with cisplatin for the treatment of patients with peritoneal mesothelioma: Outcomes of an expanded access program. Clin Lung Cancer. 2005;7(1):40–46.CrossRefPubMedGoogle Scholar
  31. 31.
    Nowak AK, Byrne MJ. Cisplatin and gemcitabine in malignant mesothelioma. Ann Oncol. 2005;16(10):1711. doi:10.1093/annonc/mdi303 CrossRefPubMedGoogle Scholar
  32. 32.
    Favaretto AG, Aversa SM, Paccagnella A, Manzini Vde P, Palmisano V, Oniga F, et al. Gemcitabine combined with carboplatin in patients with malignant pleural mesothelioma: A multicentric phase II study. Cancer. 2003;97(11):2791–2797. doi:10.1002/cncr.11405 CrossRefPubMedGoogle Scholar
  33. 33.
    Sorensen JB, Frank H, Palshof T. Cisplatin and vinorelbine first-line chemotherapy in non-resectable malignant pleural mesothelioma. Br J Cancer. 2008;99(1):44–50. doi:10.1038/sj.bjc.6604421 CrossRefPubMedGoogle Scholar
  34. 34.
    Yan TD, Edwards G, Alderman R, Marquardt CE, Sugarbaker PH. Morbidity and mortality assessment of cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma—a prospective study of 70 consecutive cases. Ann Surg Oncol. 2007 Feb;14(2):515–525. doi:10.1245/s10434-006-9187-5 CrossRefPubMedGoogle Scholar
  35. 35.
    Brigand C, Monneuse O, Mohamed F, Sayag-Beaujard AC, Isaac S, Gilly FN, et al. Peritoneal mesothelioma treated by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy: results of a prospective study. Ann Surg Oncol. 2006;13(3):405–412. doi:10.1245/ASO.2006.05.041 CrossRefPubMedGoogle Scholar
  36. 36.
    Costamagna D, Scuderi S, Vaira M, Barone R, De Simone M. Treatment of peritoneal mesothelioma using cytoreduction and intraperitoneal hyperthermic chemotherapy. Tumori. 2003;89(4 Suppl):40–42.PubMedGoogle Scholar
  37. 37.
    Hassan R, Ebel W, Routhier EL, Patel R, Kline JB, Zhang J, et al.: Preclinical evaluation of MORAb-009 a chimeric antibody targeting tumor-associated mesothelin. Cancer Immun 2007, 7:20.PubMedGoogle Scholar
  38. 38.
    Hassan R, Bullock S, Premkumar A, Kreitman RJ, Kindler H, Willingham MC, et al. Phase I study of SS1P, a recombinant anti-mesothelin immunotoxin given as a bolus I.V. infusion to patients with mesothelin-expressing mesothelioma, ovarian, and pancreatic cancers. Clin Cancer Res 2007;13(17):5144–5149. doi:10.1158/1078-0432.CCR-07-0869 CrossRefPubMedGoogle Scholar
  39. 39.
    Lockhart AC, Bukowski R, Rothenberg ML, Wang KK, Cooper W, Grover J, et al. Phase I trial of oral MAC-321 in subjects with advanced malignant solid tumors. Cancer Chemother Pharmacol 2007;60(2):203–209. doi:10.1007/s00280-006-0362-y CrossRefPubMedGoogle Scholar
  40. 40.
    Krug LM, Curley T, Schwartz L, Richardson S, Marks P, Chiao J, et al. Potential role of histone deacetylase inhibitors in mesothelioma: clinical experience with suberoylanilide hydroxamic acid. Clin Lung Cancer. 2006;7(4):257–261.CrossRefPubMedGoogle Scholar
  41. 41.
    Sterman DH, Recio A, Carroll RG, Gillespie CT, Haas A, Vachani A, et al. A phase I clinical trial of single-dose intrapleural IFN-beta gene transfer for malignant pleural mesothelioma and metastatic pleural effusions: high rate of antitumor immune responses. Clin Cancer Res. 2007;13(15 Pt 1):4456–4466. doi:10.1158/1078-0432.CCR-07-0403 CrossRefPubMedGoogle Scholar
  42. 42.
    Vachani A, Sterman DH, Albelda SM. Cytokine gene therapy for malignant pleural mesothelioma. J Thorac Oncol. 2007;2(4):265–267. doi:10.1097/01.JTO.0000283041.12165.54 CrossRefPubMedGoogle Scholar
  43. 43.
    Sterman DH, Recio A, Vachani A, Sun J, Cheung L, DeLong P, et al. Long-term follow-up of patients with malignant pleural mesothelioma receiving high-dose adenovirus herpes simplex thymidine kinase/ganciclovir suicide gene therapy. Clin Cancer Res. 2005;11(20):7444–7453. doi:10.1158/1078-0432.CCR-05-0405 CrossRefPubMedGoogle Scholar
  44. 44.
    Ogino H, Yano S, Kakiuchi S, Yamada T, Ikuta K, Nakataki E, et al. Novel dual targeting strategy with vandetanib induces tumor cell apoptosis and inhibits angiogenesis in malignant pleural mesothelioma cells expressing RET oncogenic rearrangement. Cancer Lett. 2008;265(1):55–66. doi:10.1016/j.canlet.2008.02.018 CrossRefPubMedGoogle Scholar
  45. 45.
    Zervos MD, Bizekis C, Pass HI. Malignant mesothelioma 2008. Curr Opin Pulm Med. 2008;14(4):303–309. doi:10.1097/MCP.0b013e328302851d CrossRefPubMedGoogle Scholar
  46. 46.
    Palumbo C, Bei R, Procopio A, Modesti A. Molecular targets and targeted therapies for malignant mesothelioma. Curr Med Chem. 2008;15(9):855–867. doi:10.2174/092986708783955446 CrossRefPubMedGoogle Scholar
  47. 47.
    Porret E, Madelaine J, Galateau-Salle F, Bergot E, Zalcman G. Epidemiology, molecular biology, diagnostic and therapeutic strategy of malignant pleural mesothelioma in 2007—an update. Rev Mal Respir 2007;24(8 Pt 2):6S157–6S164.PubMedGoogle Scholar
  48. 48.
    Fennell DA, Gaudino G, O’Byrne KJ, Mutti L, van Meerbeeck J. Advances in the systemic therapy of malignant pleural mesothelioma. Nat Clin Pract Oncol. 2008;5(3):136–147. doi:10.1038/ncponc1039 CrossRefPubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  • Mary E. Hesdorffer
    • 1
  • John Chabot
    • 2
  • Carolyn DeRosa
    • 2
  • Robert Taub
    • 2
  1. 1.Mesothelioma Applied Research FoundationSanta BarbaraUSA
  2. 2.Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia UniversityNew YorkUSA

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