An NIH study claims to have found a better way to predict treatment response and survival in peritoneal mesothelioma patients. The information could be used to individualize treatment planning and determine which patients are most likely to benefit from aggressive therapies.
Peritoneal mesothelioma is a rare type of cancer that arises in the thin membrane that lines the walls of the abdomen. Like all forms of mesothelioma, it is highly aggressive, spreading across the membrane quickly and metastasizing to other parts of the body. It is usually caused by exposure to asbestos sometime in the patient’s past.
Treatment for peritoneal mesothelioma usually consists of surgery to remove as much of the tumor as possible (cytoreductive surgery) followed by a wash of heated chemotherapy drugs through the open body cavity (hyperthermic intraperitoneal chemotherapy – HIPEC). Because the treatment is highly invasive and prone to complications, it is not necessarily the best choice for every peritoneal mesothelioma patient.
To come up with a way to choose the best candidates for the CRS/HIPEC approach and more accurately assess prognosis in all peritoneal mesothelioma patients, NIH researchers analyzed 104 peritoneal mesothelioma patients who underwent CRS and cisplatin-based HIPEC. They then used 25 demographic, laboratory, operative and histopathological variables to develop a predictive graphical calculator or ‘nomogram’ to aid clinicians in their care of peritoneal mesothelioma patients.
The analysis revealed that 66% of patients had a completeness of cytoreduction score of 0 or 1. Eighty-seven percent of patients had the epithelioid variety of mesothelioma. The median follow-up time was 49 months. Fifty-eight percent of patients were still alive at 3 years and 46% were still living at 5 years. The three factors that appear to have the biggest impact on overall survival and figured highly in the new nomogram were pre-surgical peritoneal carcinomatosis index (a measure of the extent of cancer on the peritoneum), histological subtype, and preoperative serum CA-125.
According to the NIH researchers, the nomogram uses color coding to make it easier for clinicians to quickly estimate an individual patient’s survival odds before surgery. In a summary of the report published recently in the Annals of Surgical Oncology, the team concludes, "Pre-CRS estimation of survival times may potentially individualize patient care by influencing the use of systemic therapy and frequency of diagnostic imaging, and might prevent CRS in patients unlikely to achieve favorable outcomes despite surgical intervention.”