Annals of Surgical Oncology

, Volume 25, Issue 8, pp 2159–2164 | Cite as

Current Management and Future Opportunities for Peritoneal Metastases: Peritoneal Mesothelioma

  • H. Richard AlexanderJr.
  • Claire Yue Li
  • Timothy J. Kennedy
Gastrointestinal Oncology



Diffuse malignant peritoneal mesothelioma (MPM) is a rare and ultimately fatal cancer that was first described just over a century ago. It is a diffuse malignancy arising from the mesothelial lining of the peritoneum; morbidity and mortality from MPM is due to its propensity to progress locoregionally within the abdominal cavity.


The purpose of this article is to review the current state-of-the-science related to the diagnosis, staging, and treatment of MPM.


The condition afflicts men and women equally and the peak incidence is between 55 and 60 years of age although it can arise in the young and elderly. Patients afflicted with MPM most commonly present with nonspecific abdominal symptoms that usually lead to diagnosis when the condition is relatively advanced. Historically, median overall survival for MPM patients without treatment is < 1 year. The couplet of systemic pemetrexed and cisplatin has an overall response rate of approximately 25% and a median overall survival of approximately 1 year.


The available data, almost all retrospective in nature, have shown that in selected patients, operative cytoreduction (CRS) and regional chemotherapy administered as hyperthermic intraoperative peritoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC) is associated with long-term survival. Studies on the molecular biology of MPM have yielded new insights relating to the potentially important role of the phosphoinsitide-3-kinase/mammalian target of rapamycin (PI3 K/mTOR) pathways and immune checkpoint inhibitors that may translate into new therapeutic options for patients with diffuse MPM.


  1. 1.
    Antman K, Pomfret F, Aisner J, et al. Peritoneal mesothelioma: natural history and response to chemotherapy. J Clin Oncol. 1983;1:386–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Sugarbaker PH, Acherman YI, Gonzalez-Moreno S, et al. Diagnosis and treatment of peritoneal mesothelioma: The Washington Cancer Institute experience. Semin. Oncol 2002;29:51–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Sugarbaker PH, Welch LS, Mohamed F, Glehen O. A review of peritoneal mesothelioma at the Washington Cancer Institute. Surg Oncol Clin N Am. 2003;12:605–621.Google Scholar
  4. 4.
    Moertel C. Peritoneal mesothelioma. Gastroenterology. 1972;63:346–50.PubMedGoogle Scholar
  5. 5.
    Kaya H, Sezgi C, Tanrikulu AC, et al. Prognostic factors influencing survival in 35 patients with malignant peritoneal mesothelioma. Neoplasma. 2014;61:433–38.CrossRefPubMedGoogle Scholar
  6. 6.
    Alexander HR, Hanna N, Pingpank JF. Clinical results of cytoreduction and HIPEC for malignant peritoneal mesothelioma. Cancer Treat Res. 2007;134:343–55.PubMedGoogle Scholar
  7. 7.
    Manzini Vde P, Recchia L, Cafferata M, et al. Malignant peritoneal mesothelioma: a multicenter study on 81 cases. Ann Oncol. 2010; 21: 348–53.CrossRefPubMedGoogle Scholar
  8. 8.
    Husain AN, Colby TV, Ordonez NG, et al. Guidelines for pathologic diagnosis of malignant mesothelioma: 2017 Update of the consensus statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med 2018;142(1):89–108.CrossRefPubMedGoogle Scholar
  9. 9.
    Comin CE, Saieva C, Messerini L. h-caldesmon, calretinin, estrogen receptor, and Ber-EP4: a useful combination of immunohistochemical markers for differentiating epithelioid peritoneal mesothelioma from serous papillary carcinoma of the ovary. Am J Surg Pathol. 2007;31:1139–48.CrossRefPubMedGoogle Scholar
  10. 10.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.CrossRefPubMedGoogle Scholar
  11. 11.
    Yan TD, Deraco M, Elias D, et al. A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database*. Cancer 2011;117(9):1855–63.CrossRefPubMedGoogle Scholar
  12. 12.
    Alexander HR Jr, Bartlett DL, Pingpank JF, et al. Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma. Surgery. 2013;153:779–86.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Helm JH, Miura JT, Glenn JA, et al. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2015;22(5):1686–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Baratti D, Kusamura S, Cabras AD et al. Diffuse malignant peritoneal mesothelioma: long-term survival with complete cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Eur J Cancer. 2013;49:3140–48.CrossRefPubMedGoogle Scholar
  15. 15.
    Yan TD, Deraco M, Baratti D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27:6237–42.CrossRefPubMedGoogle Scholar
  16. 16.
    Li YC, Khashab T, Terhune J et al. Preoperative thrombocytosis predicts shortened survival in patients with malignant peritoneal mesothelioma undergoing operative cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2017;24:2259–65.CrossRefPubMedGoogle Scholar
  17. 17.
    Miura JT, Johnston FM, Gamblin TC, Turaga KK. Current trends in the management of malignant peritoneal mesothelioma. Ann Surg Oncol. 2014;21:3947–53.CrossRefPubMedGoogle Scholar
  18. 18.
    Liu S, Staats P, Lee M, et al. Diffuse mesothelioma of the peritoneum: correlation between histological and clinical parameters and survival in 73 patients. Pathology. 2014;46:604–09.CrossRefPubMedGoogle Scholar
  19. 19.
    Yan TD, Haveric N, Carmignani CP, et al. Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Cancer. 2005;103:839–49.CrossRefPubMedGoogle Scholar
  20. 20.
    Low RN, Barone RM. Combined diffusion-weighted and gadolinium-enhanced MRI can accurately predict the peritoneal cancer index preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol. 2012;19:1394–1401.CrossRefPubMedGoogle Scholar
  21. 21.
    Magge D, Zenati MS, Austin F, et al. Malignant peritoneal mesothelioma: prognostic factors and oncologic outcome analysis. Ann Surg Oncol. 2014;21:1159–65.CrossRefPubMedGoogle Scholar
  22. 22.
    Janne PA, Wozniak AJ, Belani CP, 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;7:40–46.CrossRefPubMedGoogle Scholar
  23. 23.
    Zalcman G, Mazieres J, Margery J, et al. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet. 2016;387:1405–14.CrossRefPubMedGoogle Scholar
  24. 24.
    Deraco M, Baratti D, Hutanu I, et al. The role of perioperative systemic chemotherapy in diffuse malignant peritoneal mesothelioma patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2013;20:1093–1100.CrossRefPubMedGoogle Scholar
  25. 25.
    Kepenekian V, Elias D, Passot G, et al. 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.CrossRefPubMedGoogle Scholar
  26. 26.
    Kanteti R, Dhanasingh I, Kawada I, et al. MET and PI3K/mTOR as a potential combinatorial therapeutic target in malignant pleural mesothelioma. PLoS ONE. 2014;9:e105919.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Varghese S, Chen Z, Bartlett DL, et al. Activation of the phosphoinositide-3-kinase and mammalian target of rapamycin signaling pathways are associated with shortened survival in patients with malignant peritoneal mesothelioma. Cancer. 2011;117:361–71.CrossRefPubMedGoogle Scholar
  28. 28.
    Maio M, Scherpereel A, Calabro L, et al. Tremelimumab as second-line or third-line treatment in relapsed malignant mesothelioma (DETERMINE): a multicentre, international, randomised, double-blind, placebo-controlled phase 2b trial. Lancet Oncol. 2017;18(9):1261–73.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • H. Richard AlexanderJr.
    • 1
  • Claire Yue Li
    • 1
  • Timothy J. Kennedy
    • 1
  1. 1.The Rutgers Cancer Institute of New Jersey and the Department of SurgeryRutgers Robert Wood Johnson Medical SchoolNew BrunswickUSA

Personalised recommendations