Surgeon Brian Loggie, M.D., hopes to end the continued debate over which chemotherapy agent is the best to use during the HIPEC procedure that he helped pioneer for peritoneal mesothelioma patients.
There is no doubt in his mind: Carboplatin.
The American Surgeon recently published a retrospective study in which Loggie and his colleagues at the Creighton University Medical Center concluded that carboplatin clearly was more effective than mitomycin, which several cancer centers are using.
The HIPEC (Hyperthermic Intraperitoneal Chemotherapy) procedure involves the internal rinsing or bathing of the abdominal area with a chemotherapy-based solution heated to 108 degrees Fahrenheit.
The procedure accompanies cytoreductive surgery that removes the visible cancer tumors. The HIPEC, which involves circulating the solution in the abdomen for two hours, is designed to kill any remaining cancer cells that were not visible to the surgeon.
“I think it’s time to change the clinical practice,” Loggie told Asbestos.com recently. “The data [in the study] is in-your-face data. You can see the difference right away in patients. It’s significant. I’m convinced this is the way to go.”
Peritoneal mesothelioma is a rare cancer caused by exposure to asbestos and diagnosed in fewer than 1,000 patients annually in the U.S. It initially is found in the thin lining surrounding the organs in the abdominal cavity. There is no cure, although treatments like the HIPEC have made a big difference in survival rates recently.
Patients Living Longer
Loggie’s patients are living longer than before, many three years or more from the time they were diagnosed. Several have lived five years and beyond. Patients getting only systemic chemotherapy, and not surgery and HIPEC, still are projected to live just 12-15 months.
HIPEC itself has not been accepted totally by cancer centers across the country and, many surgeons and medical oncologists remain skeptical that it provides a definitive benefit. Not all cancer centers have the necessary and expensive equipment required to do the procedure.
“It boggles my mind that some medical oncologists still don’t believe in the procedure. There is just a close-mindedness sometimes, and that’s too bad,” he said. “If I didn’t see a clear benefit, why would I still be doing it?”
Loggie was one of the first surgeons in the U.S. to perform the HIPEC procedure in 1992 when he was working at the Wake Forest Medical Center. He has used several different chemotherapy drugs over the past 20 years.
Cisplatin, doxorubicin and mitomycin also have been used with HIPEC.
The study at the Creighton Medical Center included 44 mesothelioma patients and 47 procedures from 2003 to 2010. Loggie was the primary surgeon in each case.
Data Hard to Dispute
The one-year survival rate in the mitomycin group was 72.3 percent, compared with 89.7 percent for the carboplatin group. The five-year survival was only 27.3 percent for mitomycin but 62.5 percent for carboplatin.
The average length of time in intensive care and the average mean hospital stay was considerably shorter in patients who received the carboplatin. The carboplatin group also required fewer blood transfusions.
Three of the 44 patients underwent a second procedure with carboplatin after first having it done with mitomycin. They were excluded from the final results that consisted of 11 patients who had only mitomycin and 30 who had only carboplatin.
Of the three who were treated twice, two had a recurrence within the first year and were then retreated with carboplatin. One of the three had a second recurrence and died three years after the second HIPEC treatment. The second patient lived another 96 months after diagnosis, and the third still was living 87 months after diagnosis.
“You could see it in the clinic. Patients [with the carboplatin] were much easier to look after,” he said. “It only took a few patients to realize that. What I don’t understand is the reticence to look at this closer, on a larger scale. The difference in outcomes, if anything, really helped to validate the HIPEC.”
Carboplatin also is being used at the Creighton Medical Center, and a few other cancer centers for the treatment of epithelial ovarian cancers. Many centers use cisplatin and mitomycin despite the drugs higher rate for serious side effects.
“I’m not surprised what we found [in our study], just pleased to see the improvement,” Loggie said.