Surgeon Paul Sugarbaker at the Washington Cancer Institute has nearly doubled the five-year survival rate for patients with peritoneal mesothelioma by adding long-term regional chemotherapy to his already groundbreaking protocol.
Sugarbaker, a pioneer in advancing peritoneal mesothelioma treatment for more than two decades, believes this latest development could have far-reaching implications.
“This could be a game changer,” Sugarbaker told Asbestos.com. “The reaction has been, ‘Wow! [It’s] hard to believe.’ We’ve got to exploit this [advancement] as best as we can.”
Sugarbaker, who is also medical director at the MedStar Washington Hospital Center, detailed results of his latest study in the European Journal of Surgical Oncology.
The study included a five-year survival of 75 percent for those receiving the latest normothermic intraperitoneal chemotherapy (NIPEC) following hyperthermic perioperative chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC).
The five-year survival rate for patients receiving only the surgery and HIPEC was 44 percent. Patients getting surgery, HIPEC and EPIC had a five-year survival rate of 52 percent.
All patients had the epithelioid cell type of mesothelioma, and Sugarbaker performed all surgeries over the past 20 years.
Surgeons use NIPEC regularly for ovarian cancer, but Sugarbaker first used it for peritoneal mesothelioma cancer in 2012. He remains the only surgeon using it consistently today.
NIPEC involves an intraperitoneal port that is implanted after surgery but prior to abdominal closure. The chemotherapy is repeated every three weeks for six cycles.
“We can’t guarantee a good result for patients,” Sugarbaker said. “But we can guarantee a good try now.”
Peritoneal mesothelioma, which starts in the thin membrane surrounding the abdominal organs, is rare and diagnosed in a less than 1,000 people annually within the United States.
By comparison, pleural mesothelioma is diagnosed in more than twice as many patients. Both are caused by an ingestion or inhalation of toxic asbestos fibers. The rarity of peritoneal mesothelioma makes it imperative for patients to find a specialist with experience treating it. The NIPEC procedure is just the latest example of why.
“It’s just not a disease for the medical oncologist. Too many times, they say there’s nothing you can do. It’s a disease for the experienced. Someone dedicated and committed to treating it,” Sugarbaker said. “It’s absolutely crucial for a patient to find that.”
Sugarbaker was instrumental in creating the HIPEC two decades ago, adding it to aggressive cytoreductive surgery that removes the lining and all visible tumor cells throughout the abdominal area.
The subsequent HIPEC involves using a heated chemotherapy-based solution to internally bathe the abdominal area for 90 minutes before it is drained and the abdomen closed. It is designed to kill any remaining tumor cells the surgeon may have missed.
Sugarbaker recently co-authored another report for the International Journal of Hyperthermia, calling for more standardization of intraperitoneal chemotherapy for various cancers, including mesothelioma.
Although the combination of surgery and intraperitoneal chemotherapy is accepted as standard of care, there is no universally accepted dosage, duration or specific drug combination. He believes it would lead to longer survival for all.
“Pharmacologic evidence should be generated to answer important questions raised by the myriad of variables associated with IP chemotherapy,” the authors wrote. “We are still lacking a much-needed standardization.”
The Washington Cancer Institute was involved in a 2014 retrospective analysis of peritoneal mesothelioma cancer detailing the survival benefits of repeating the cytoreductive surgery and HIPEC a second and third time after tumor recurrence.
In that study, the median overall survival rate was 77 months for the first procedure and 55 months for those repeating the procedure.
Sugarbaker last week cautioned that although the addition of NIPEC produced impressive results for him, more study is needed to confirm his findings.
“Hopefully, the start of a randomized control study by the end of the year will begin,” he said. “That would be the next step.”