Transarterial Chemoperfusion Treatment of Unresectable Pleural Mesothelioma – a Phase 2 Prospective Study

Monday, March 6, 2023

4:03 PM – 4:12 PM

Location: Phoenix Convention Center, 225AB

Featured Presenter(s)

Bela Kis, MD, PhD

Associate Member in the Diagnostic Imaging & Interventional Radiology Program
Moffitt Cancer Center

Disclosure information not submitted.

Author/Co-author(s)

MP

Malesa Pereira, n/a

medical student
Moffitt Cancer Center
JK

Jongphil Kim, PhD

ASSOCIATE MEMBER FACULTY RS QS
Moffitt Cancer Center
Ghassan El-Haddad, MD

Associate Member Interventional Radiology, Head of Radionuclide Therapy Program
Moffitt Cancer Center and Research Institute
JC

Junsung Choi, MD

SR MBR DIAGRADINT
H. Lee Moffitt Cancer Center
JF

Jacques Fontaine, MD

SR MBR THORCARDIO
Moffitt Cancer Center
AS

Andreas Saltos, MD

ASST MBR HEMONCMED
Moffitt Cancer Center
BC

Benjamin Creelan, MD

ASSOC MBR HEMONCMED
Moffitt Cancer Center
TT

Tawee Tanvetyanon, MD

SR MBR HEMONCMED
Moffitt Cancer Center

Disclosure(s):

Bela Kis, MD, PhD: Varian Medical Systems: Consultant (Ongoing)

Ghassan El-Haddad, MD: No relevant disclosure to display

Purpose:

Transarterial chemoperfusion treatment selectively delivers relatively high concentration of chemotherapy to the targeted tissue’s arterial bed maximizing antitumoral effect and minimizing systemic side effects. Advanced malignant pleural mesothelioma (MPM) carries a very poor prognosis. The current prospective study (ClinicalTrials.gov Identifier: NCT02611037) investigated the disease control rate, overall survival and adverse events of transarterial chemoperfusion treatment in patients with relapsed unresectable MPM.

Materials and Methods:

32 patients, 5 female and 27 males (age 71.7±6.9 years), with MPM were enrolled between 3/2016-4/2021. ECOG performance status was 0 and 1 (12.5% and 87.5%, respectively). Patients had transarterial chemoperfusion treatment in every 4 weeks with cisplatin (35 mg/m²), methotrexate (100 mg/m²) and gemcitabine (1000 mg/m²) via the ipsilateral internal mammary artery and/or descending thoracic aorta. All patients had received and progressed on prior chemotherapy. 5 patients also had prior radiation therapy and 3 patients had pleurectomy. The number of prior systemic chemo- and immunotherapy was 1.96±1.3 (range: 1-6). Response rate was evaluated by modified RECIST for mesothelioma.

Results:

At the data cutoff date (October 10, 2022) 30 of the 32 patients had died. A total of 199 chemoperfusion treatments were performed. The median number of treatments was 3/patient (range 1-53). The disease control rate was 75% (1 PR, 23 SD, 8 PD). Median progression free survival from the enrollment was 4.7 months (95% CI 2.5-7.4). Median OS was 8.9 months (95% CI 5.7-15). OS at 6, 12, 18, 24 and 36 months were 69%, 41%, 14%, 7%, and 5%, respectively. There was no treatment related mortality. Major complication rate (grade 3 adverse events) was 1% (2 events). The most common grade 1 or 2 adverse events were nausea and anemia (both occurred in 47% of patients), followed by hypomagnesemia (44%), hyperkalemia (41%) and lymphopenia (31%).

Conclusion:

Transarterial chemoperfusion treatment with cisplatin, methotrexate and gemcitabine in every 4 weeks is feasible and safe. The treatment has promising disease control rate and OS in this group of heavily pretreated patients with relapsed MPM.