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Non-resectable Malignant Peritoneal Mesothelioma Treated with Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Plus Systemic Chemotherapy Could Lead to Secondary Complete Cytoreductive Surgery: A Cohort Study

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Abstract

Background

Diffuse malignant peritoneal mesothelioma (DMPM) is an aggressive primary peritoneal neoplasia. At diagnosis, few patients are eligible for a recommended cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Among neoadjuvant strategies, pressurized intraperitoneal aerosol chemotherapy (PIPAC) combined with systemic chemotherapy has been recently proposed. This study evaluated this strategy in a cohort of DMPM patients.

Methods

Patients with DMPM and primary or recurrent non-resectable diseases who received at least one PIPAC procedure in alternation with systemic chemotherapy were included in this retrospective study to analyze oncologic outcomes.

Results

Overall, 26 DMPM patients were treated with at least one PIPAC, including 20 patients with no previous CRS. Of 22 patients (85%) who had symptoms, 9 had perceptible ascites. Overall, 79 PIPAC procedures were performed, with half of the patients receiving three PIPAC procedures or more. Among eight patients (31%), 10 adverse events (13% of procedures) were reported, including two severe complications, both corresponding to digestive perforations. Improvement of symptoms was reported for 32% of the patients, whereas control of ascites was noted in 46%. All but one procedure among 14 patients (54%) secondarily treated by CRS-HIPEC were considered complete resections. After a median follow-up period of 29.6 months (95% confidence interval [CI], 17.6–not reached [NR]), the median overall survival period was 12 months (95% CI 11.1–NR). The median progression-free survival (PFS) was significantly better among the patients who underwent resection than among those who did not (33.5 vs 7.4 months; hazard ratio [HR], 0.18; 95% CI 0.06–0.755; p < 0.001).

Conclusions

For patients with initially non-resectable DMPM, PIPAC is feasible for treatment with neoadjuvant intent and could facilitate complete secondary resection.

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Acknowledgment

We thank Cécile Odin for her assistance in the collection of clinical data.

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Authors and Affiliations

  1. Service de Chirurgie Digestive, Hospices Civils de Lyon, Hôpital Lyon Sud, Université Lyon-1, Pierre-Bénite, Lyon, France

    Vahan Kepenekian MD, PhD, Isabelle Bonnefoy BSC, Naoual Bakrin MD, PhD & Olivier Glehen MD, PhD

  2. Faculté de Médecine Lyon-Sud, Université de Lyon, Université Claude Bernard Lyon 1, EA3738 CICLY, Lyon, France

    Vahan Kepenekian MD, PhD, Benoit You MD, PhD, Isabelle Bonnefoy BSC, Laurent Villeneuve PhD, Naoual Bakrin MD, PhD, Pascal Rousset MD, PhD, Nazim Benzerdjeb MD, PhD & Olivier Glehen MD, PhD

  3. Service d’oncologie Médicale, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France

    Julien Péron MD, PhD & Benoit You MD, PhD

  4. Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Université Claude Bernard Lyon 1, Villeurbanne, France

    Julien Péron MD, PhD

  5. Service de Recherche et d’Epidémiologie Cliniques, Hospices Civils de Lyon, Hôpital Lyon Sud, Université Lyon-1, Lyon, France

    Laurent Villeneuve PhD

  6. Department of Surgical Oncology, King Khalid University Hospital, Najran, Saudi Arabia

    Mohammad Alyami MD, PhD

  7. Service d’Imagerie, Hospices Civils de Lyon, Hôpital Lyon Sud, Université Lyon-1, Lyon, France

    Pascal Rousset MD, PhD

  8. Laboratoire d’Anatomie et Cytologie Pathologiques, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France

    Nazim Benzerdjeb MD, PhD

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  1. Vahan Kepenekian MD, PhD
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  2. Julien Péron MD, PhD
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Correspondence to Vahan Kepenekian MD, PhD.

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Disclosure

Olivier Glehen is a consultant for Gamida. The French network for the treatment of rare peritoneal malignancies (RENAPE) was sponsored by the French National Cancer Institute (INCa). There are no conflicts of interest.

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Kepenekian, V., Péron, J., You, B. et al. Non-resectable Malignant Peritoneal Mesothelioma Treated with Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Plus Systemic Chemotherapy Could Lead to Secondary Complete Cytoreductive Surgery: A Cohort Study. Ann Surg Oncol 29, 2104–2113 (2022). https://doi.org/10.1245/s10434-021-10983-2

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