Long-Term Survival in Unresectable Malignant Peritoneal Mesothelioma With PIPAC: A Case Report

A patient with unresectable malignant peritoneal mesothelioma (MPM) who received pressurized intraperitoneal aerosol chemotherapy (PIPAC) monotherapy achieved long-term survival without major surgical or toxic side effects, according to a recent case report.

A team of researchers from the University Hospital of Leipzig in Leipzig, Germany, reported the case in Pleura and Peritoneum. The case was significant because MPM is a “rare disease with unspecific abdominal symptoms which is therefore often diagnosed at an advanced stage.” In addition, “Curative therapy is delivered by radical surgery, whereas palliative therapy consists of systemic chemotherapy.”

The male patient at the center of the case report received individualized PIPAC treatment for unresectable MPM and began treatment in 2017 due to “extensive disease on the small bowel.” The patient declined to receive systemic chemotherapy as the typical standard of care.

The investigators initiated PIPAC with doxorubicin and cisplatin, and the patient achieved stable disease within 1 year of the treatment. As a result of this development, PIPAC was discontinued for 2.5 years.

After 2.5 years, the disease progressed, and the patient received treatment with PIPAC, which resulted in stable disease for an additional 2 years. The investigators reported that the patient received 24 PIPAC procedures over a total of 7 years.

In reflecting on the results, the authors of the case report hypothesized that the patient achieved 7-year long-term survival “because he was therapy-naïve, preventing the tumor from developing chemoresistance to previous regimens.”

They noted that several other factors could have contributed to this outcome, including the patient’s age at presentation, the histologic subtype, which was “partially papillary with an invasive epitheloid component,” and the absence of extra-abdominal metastases that would typically limit PIPAC as a “local intra-abdominal treatment.”

The investigators explained that the confluence of these factors allowed for the total of “24 repetitive PIPACs with cisplatin and doxorubicin” and emphasized that up until the last year of treatment the patient “maintained excellent general condition with no significant limitations in quality of life.”

“This is an important finding which stresses the feasibility, efficacy, and acceptance of repeat PIPAC procedures in MPM,” the case report authors concluded.