Surgeon Details First North American PITAC for Mesothelioma
Treatment & Doctors
Written by Sean Marchese | Edited by Amy Edel
Thoracic surgeon Dr. Leah Backhus tells us a Stanford team has performed a specialized procedure for pleural mesothelioma for the very first time in North America. Known as pressurized intrathoracic aerosol chemotherapy, it delivers chemotherapy directly into the chest as a pressurized mist. Dr. Backhus noted, “I call it spray paint chemo.”
PITAC is minimally invasive while still fighting this aggressive cancer. Dr. Backhus explains the aerosolized chemo may reach “the cracks and crevices” of the chest better than traditional chemo for mesothelioma can after surgery. She added that PITAC may help fill a gap between major surgery and simple symptom control.
For patients ineligible for more radical mesothelioma surgeries, PITAC may offer an important option. It can both treat the cancer and relieve uncomfortable symptoms like pleural effusions, improving quality of life.
A Lower-Risk Option For Select Patients
Dr. Backhus says PITAC stands out because more patients may be eligible for it than radical surgery. “It threads a needle,” she tells us, describing it as a treatment with early promise and “very, very low” harm compared with higher-risk operations.
That matters in pleural mesothelioma, where treatment decisions are often difficult and highly individualized. Backhus says some patients aren’t well enough to tolerate a major surgery such as pleurectomy/decortication.
The role of surgery for pleural mesothelioma has been at the center of debate since the MARS 2 trial results were released. The results put the survival benefits of pleurectomy/decortication surgery in question. However, a recent Mount Sinai study spotlighted nuances in the discussion, finding that with careful patient selection, lung-sparing surgery can have positive outcomes and very low mortality. And now PITAC may expand options for those patients who don’t qualify for P/D.
Why Careful Patient Selection Matters for PITAC
PITAC is best suited for mesothelioma patients with pleural effusion and cancer spread contained in the chest, a 2025 University of Pisa study reports. Based on these criteria, Dr. Backhus shares that the first Stanford PITAC patient was a strong PITAC candidate.
“So her tumor burden was incredibly low,” Dr. Backhus explains. “But she was symptomatic because she had these effusions.”
The patient, a woman in her 70s, had previously undergone surgery and HIPEC for peritoneal mesothelioma. She had been without evidence of disease for more than a year before developing a pleural effusion that raised concern for mesothelioma in the chest.
Dr. Backhus recounts she took the patient to surgery for a pleural biopsy and pleurodesis. Even though she saw no visible pleural disease, blind biopsies came back positive for mesothelioma. The team hoped the procedure would both treat the effusion and possibly delay systemic therapy.
How PITAC Compares With Other Mesothelioma Surgical Options
Dr. Backhus performed PITAC through a standard video-assisted thoracic surgery approach using 2 small ports. The chemo is misted into the chest, given time to absorb into the tissue and then a chest tube is placed to complete the procedure.
PITAC patients typically go home within about 2 days, she explains, and pain is generally manageable. A pleurodesis, which manages the fluid buildup of a pleural effusion but doesn’t treat cancer directly, has a typical hospital stay of 3 to 5 days. P/D surgery with hyperthermic intrathoracic chemotherapy usually involves a hospital stay of 7 to 10 days and a surgical recovery of several months.
“If PITAC is a level two,'” Dr. Backhus says, “then P/D with HITHOC is like a level 15 on a scale of one to 10.” PITAC treats the cancer like P/D with HITHOC, but with the reduced physical toll of a pleurodesis.
Where PITAC Fits in the Treatment Landscape
Dr. Backhus explains PITAC can be a good option for patients who want both palliative therapies to stay as comfortable as possible and to remove, kill or slow cancer cells. Tumor-removing (cytoreductive) surgeries and cancer-targeted chemo (cytotoxic) are often paired as with P/D and HITHOC. PITAC offers similar benefits, but with a minimally invasive procedure.
“If you want to be palliated, but you also still want to try to maintain some degree of cytotoxicity to buy you more time, in addition to symptom palliation, then that’s what we’re talking about here,” Dr. Backhus says. For patients with extensive pleural disease, she says she still favors P/D with HITHOC.
PITAC may be the more appropriate path for patients who aren’t healthy enough for that level of intervention. It may also benefit patients for whom P/D would actually be more challenging. This includes those with very little visible disease, where removing the pleural lining is technically more difficult.
How Can Pleural Mesothelioma Patients Access PITAC?
Right now, Stanford is offering PITAC through a registry and using clinical judgment to select patients. Backhus tells us the team is tracking quality-of-life measures and closely monitoring whether pleural effusions recur, which is one of the easiest early signs to follow.
The next step is a phase 1 pilot study focused on safety. She says if effusions stay controlled and quality of life holds, future research can take on bigger questions about disease control and survival.
“At minimum we have to try not to harm this vulnerable group of patients,” Backhus adds. “And if we can, on top of that, actually try to combat the disease and keep it at bay and prolong life, then that would be a huge win.”
Why PITAC’s Potential for Pleural Mesothelioma Is Encouraging
At a time when mesothelioma specialists are still looking for better ways to balance disease control and quality of life, Dr. Backhus says there’s reason to be cautiously optimistic. The data so far are encouraging on safety. But she cautions that unanswered questions remain about long-term outcomes.
Enduring effectiveness is a concern for pleural patients who can experience mesothelioma recurrence. She says for now, “we don’t know” how lasting PITAC results are.
Side effects are also a concern. The main risk she discusses with her patients is the possibility of chemo affecting the kidneys. While PITAC uses a targeted mist rather than the usual delivery through the bloodstream, some of the chemo drugs can be absorbed through the pleural surface in the chest.
But Dr. Backhus adds that with PITAC “the downside” is “very little.” She says that this procedure has the potential to open options to patients who are ineligible for aggressive surgery but want a more of an intervention plan than chemo alone.
