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Clinical Trial Tackles Mesothelioma

New York (Apr 15, 2009)

A multidisciplinary team of experts at NewYork-Presbyterian Hospital/Columbia University Medical Center's renowned Mesothelioma Center has developed a unique multidisciplinary approach that combines chemotherapy, surgery, and focused radiation therapy to treat these cancers while sparing as much nearby healthy tissue as possible. This lung-sparing approach is now being evaluated through a clinical trial offered only at the Hospital's Columbia University Medical Center campus.

Mesothelioma is a cancer that strikes some 3,000 people in the U.S. each year – primarily those who have been occupationally or environmentally exposed to asbestos. Eight-five percent of cases arise in the pleura and the remainder in the peritoneum.

Treating Pleural Mesothelioma

Central to the new treatment procedure is the placement of catheters directly into the chest cavity to administer chemotherapy and, in the case of pleural mesothelioma, radioactive agents to kill cancer cells. Patients with pleural disease that is not amenable to treatment with pleurectomy or extrapleural pneumonectomy may benefit from this approach, starting with the insertion of two ports anterior and posterior to the lungs under the guidance of a thoracoscope. During this surgical procedure, patients also receive carefully heated solutions containing chemotherapy that are delivered to the pleura.

"The most common treatment for pleural mesothelioma is extrapleural pneumonectomy, but it rarely eradicates all disease," explained Robert N. Taub, MD. "But the actual data calls into question whether or not this surgery really helps. Through our approach, we have control over the pleural space and can give the patient higher, more effective doses of chemotherapy."

Over a period of eight to nine weeks, patients receive alternating weekly treatments of chemotherapy or gamma interferon delivered directly into the pleura through the ports as well as intravenous chemotherapy. Treatment can be administered in the outpatient setting.

Patients with pleural mesothelioma cannot receive external radiotherapy because it exposes the heart and lungs to radiation toxicity. So after they have completed chemotherapy, they receive a single dose of a radioisotope that bathes the pleural surfaces with higher doses of irradiation than can be achieved with an external radiation beam.

"The isotope attacks any residual cells remaining after the other treatments," said Rashid A. Fawwaz, MD, PhD. "P-32 has been used in the past as a palliative procedure, but here it has curative intent."

Treating Peritoneal Mesothelioma

The team is using a similar approach to treat peritoneal mesothelioma, called intracavitary chemotherapy, which enables clinicians to deliver higher localized doses of chemotherapy with less systemic toxicity than the conventional intravenous approach. About a third of all patients with peritoneal mesothelioma in this country are treated at NewYork-Presbyterian/Columbia.

Patients eligible for this treatment first undergo an exploratory laparotomy with removal of some abdominal contents and tumor masses followed by the insertion of two catheters, one on each side of the abdomen. They then receive chemotherapy and periodic gamma interferon through the ports over the next 12 weeks.

Upon completion of chemotherapy, the patient undergoes a second surgical procedure at which time any remaining tumor tissue is resected, the ports are removed, and a final dose of precisely heated chemotherapy is administered. Findings of a clinical protocol assessing the treatment showed that median overall survival for patients receiving this therapy was 55 months, with an advantage observed among those with epithelioid disease (71 months) versus sarcomatoid mesothelioma (11 months). Five-year survival was 45 percent.

Dr. Taub noted that the choice of chemotherapy drugs and the temperature, timing, and frequency of treatment need to be optimized in prospective clinical trials. He concluded, "This is an eradicative procedure that shows great potential for eliminating disease."

Contacting the Mesothelioma Center

For more information about this and other clinical trials at the Mesothelioma Center, contact Mary Hesdorffer, RN, Clinical Study Coordinator, at 212-305-4076.

Faculty Contributing to this Article:

Rashid A. Fawwaz, MD, PhD is an Attending Radiologist at NewYork-Presbyterian Hospital/Columbia University Medical Center, and a Professor of Clinical Radiology at Columbia University College of Physicians and Surgeons.

Robert N. Taub, MD is Director of the Mesothelioma Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, and a Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.

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