Novel Imaging May Make Peritoneal Mesothelioma Surgery More Effective
May 6, 2019
Dr. James Cusack at Massachusetts General Hospital has begun using a novel imaging system for patients with peritoneal mesothelioma that could better identify tumor cells during surgery, reducing the chance of recurrence.
Cusack, an associate professor of surgery at the Harvard University Medical School, is also studying the molecular imaging technology with select cases of appendiceal, ovarian and gastrointestinal cancers.
The single-center clinical trial, which started April 3, aims to determine safety and efficacy of the procedure for peritoneum metastases, according to Cusack.
The Lumicell System already has been studied with women undergoing lumpectomy for breast cancer. It’s been lauded for its ability to identify hard-to-detect tumor cells beyond the margin of the specimen.
This application involving cancers within the peritoneum was developed in the Cusack Laboratory.
“This feasibility study is a critical first step in determining if the Lumicell System will be effective in improving quality of life for people with peritoneal metastasis,” Cusack said in a press release announcing the start of his study. “We will be…comparing the imaging results detected on the molecular level with the traditional microscopic evaluation, to improve surgical outcomes for patients with peritoneal surface malignancies.”
Finding Hidden Tumor Cells
Peritoneal mesothelioma is a diffuse and aggressive cancer that begins in the lining around the abdominal cavity and can spread to distant organs. Exposure to asbestos is the common cause.
Recent treatment advances involving a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — often called HIPEC — have extended survival times, but cancer recurrence remains a serious problem.
HIPEC slows or stops recurrence by killing tumor cells that evaded the surgeon, but its effectiveness is limited. When cancer inevitably returns, patients often are faced with a second aggressive surgery.
The Lumicell System has an unprecedented ability to identify microscopic tumor cells for the surgeon and potentially avoid the need for more surgery.
More than 200 breast cancer patients were surgically treated using the Lumicell System in an earlier clinical trial. It showed direct identification of residual tumor during surgery that otherwise would have gone unseen.
“We’re excited to determine whether this feasibility study will bring the same advantages to treating patients with peritoneal metastases,” said Dr. Barbara Smith, professor of surgery at Harvard and director of the Breast Program at Massachusetts General Hospital. “Our study found [the Lumicell System] was effective for real time identification of residual cancer intraoperatively.”
Determining Best Dosage Levels
Patients in the study will be given an intravenous injection at the start of the surgery. The solution, called LUM015, is laboratory designed so that tumors can be better identified by a LUM Imaging device.
This trial will determine the safest dosage level.
Patients in the study will be followed until investigators determine no further surgical intervention is required.
The Cusack Laboratory, funded by the National Institutes of Health and the American Cancer Society, has been a national leader in increasing the effectiveness of anti-cancer therapies through molecular mechanisms.
Cusack formed the Peritoneal Surface Malignancy Program at Massachusetts General in 2011. He has been a pioneer in the development of the cytoreduction/HIPEC procedure for peritoneal mesothelioma.