Medias Klinikum GmbH & Co KG, Germany
Title: Isolated Thoracic Perfusion with Chemofiltration (ITP-F) breaks through drug resistance in progressive and pretreated malignant pleural mesothelioma
Biography: Karl R Aigner
Background: Survival of patients with progressive malignant pleural mesothelioma has not improved during the last decades. Treatment options are limited because of poor chemosensitivity of this disease and mostly non-operability due to advanced disease. We report on a phase II study on isolated thoracic perfusion (ITP) with subsequent chemofiltration (ITP-F) as arnlocoregional therapeutic strategy with increased drug exposure. Material & Methods: 28 patients with epitheloid mesothelioma were included in this study. 11 patients had prior surgical resection and all patients had prior Cisplatin and Pemetrexed based chemotherapy. Following multimodal therapy in allrnpatients, progress was revealed in CT-scan. No patient had abdominal, cerebral or bone metastases. Under general anesthesia, rna venous and arterial stopflow-balloon catheter was inserted via a femoral access and both blocked at the level of the diaphragm in vena cava and aorta. Chemotherapy consisting of 60 mg/m² Cisplatin and 15 mg/m² Mitoxantron was injected as pulsatilerninfusion against the aortic blood stream. After 15 minutes of ITP vascular blocks were released, followed by 45 minutes ofrnchemofiltration. Endpoints of the study were overall survival and quality of life. According to the protocol a minimum of fiverncycles each were administered.Results: Toxicity, due to chemofiltration was low with leucopenia and thrombocytopenia grade 1 in 11 patients and mucositisrngrade 2 in 6 patients. Surgical complications in terms of temporary lymph fistula in the groin occurred in 40 %. Gastrointestinal neurotoxicity was never observed. One year survival was 49%, 2 years survival was 31% and 3 years survival was 31%, 4 yearsrnsurvival was 23%. Median survival was 12 months.rnConclusion: ITP-F for pretreated patients with malignant pleural mesothelioma, progressive after multimodality therapy is arnvaluable treatment option with low side effects, offering a reasonable survival and maintaining quality of life.