Peritoneal mesothelioma is a rare and aggressive cancer that develops in the lining of the abdomen, known as the peritoneum. While often discussed alongside pleural mesothelioma, which affects the lung lining, there are significant distinctions between these two forms of mesothelioma. Due to its subtle early symptoms, Peritoneal Mesothelioma Diagnosis often occurs when the disease has already advanced.
To provide deeper insights into this unique cancer and the advancements in its treatment, we consulted with Dr. Kanwal Raghav, a distinguished gastrointestinal medical oncologist at MD Anderson Cancer Center.
How Rare is Peritoneal Mesothelioma?
Of the approximately 3,000 mesothelioma cases diagnosed annually in the United States, peritoneal mesothelioma accounts for a small fraction, between 300 and 500. At MD Anderson, a leading center for peritoneal mesothelioma, around 50 to 60 new patients are seen each year, highlighting the specialized care required for this uncommon condition.
Who is at Risk for Peritoneal Mesothelioma?
Asbestos exposure is a well-known risk factor for pleural mesothelioma, present in 80% to 90% of lung-lining mesothelioma cases. However, its association with peritoneal mesothelioma is less pronounced, identified in only about 30% to 40% of cases. This suggests that the causes of peritoneal mesothelioma are not fully understood for a significant number of patients. While asbestos exposure remains a risk factor, many other contributing factors are still under investigation.
Interestingly, peritoneal mesothelioma is observed more frequently in women, contrasting with pleural mesothelioma, which predominantly affects men. This gender disparity further underscores the distinct nature of peritoneal mesothelioma.
What are the Symptoms and Diagnostic Process for Peritoneal Mesothelioma?
Peritoneal mesothelioma symptoms are often not apparent until the later stages of the disease. Key indicators to be aware of include abdominal pain or swelling, nausea, changes in bowel habits, unexplained fever, and unintentional weight loss. A definitive peritoneal mesothelioma diagnosis requires a biopsy. This procedure involves taking a tissue sample for microscopic examination by a pathologist to confirm the presence of mesothelioma cells.
Standard Treatment Approaches for Peritoneal Mesothelioma
Historically, treatment strategies for peritoneal mesothelioma have mirrored those used for pleural mesothelioma. Notably, specific treatment guidelines tailored to peritoneal mesothelioma are still lacking. A common approach involves cytoreductive surgery, aiming to remove visible tumor tissue, often followed by Hyperthermic Intraoperative Peritoneal Perfusion with Chemotherapy (HIPEC). HIPEC is a procedure delivering heated chemotherapy directly into the abdominal cavity during surgery. When surgery is not a viable curative option, platinum-based chemotherapy is the standard initial treatment, with subsequent lines of chemotherapy considered if needed.
Advances in Peritoneal Mesothelioma Treatment and Research
A significant challenge in peritoneal mesothelioma treatment is the limited disease-specific drug research. Current standard treatments are largely extrapolated from studies focused on pleural mesothelioma. While some Phase I clinical trials include peritoneal mesothelioma patients, drawing definitive conclusions is difficult without dedicated research for this rare cancer.
Recently, promising progress has emerged. A Phase II study specifically designed for advanced peritoneal mesothelioma investigated an immunotherapy and targeted therapy combination. The findings, which have been published, demonstrated that this combination therapy was safe and yielded a positive response in 40% of the participants.
This study marked a pioneering effort in peritoneal mesothelioma research by incorporating biopsies both before and during treatment. This enabled researchers to gain a deeper understanding of the disease biology and identify potential biomarkers that could predict response to immunotherapy. Biomarkers, such as specific proteins or gene expressions identified through tumor biopsy analysis, are crucial for personalized cancer treatment approaches. For rare cancers like peritoneal mesothelioma, maximizing data collection within clinical trials is paramount. This study successfully demonstrated the feasibility of conducting trials with multiple biopsies in this patient population to explore biomarkers. Patients not only benefited from receiving potentially effective treatment but also played a vital role in advancing research by participating in these in-depth analyses.
The next critical step involves conducting larger clinical trials to further evaluate the effectiveness of this treatment combination, including its potential for newly diagnosed patients and those who may be candidates for surgery.
Important Information for Patients and Caregivers Facing Peritoneal Mesothelioma
Significant efforts are underway to develop and expand clinical trials specifically for peritoneal mesothelioma. Participation in clinical trials, particularly for rare cancers, is crucial for progress and relies heavily on the support of patients and their caregivers. Patients diagnosed with peritoneal mesothelioma are encouraged to seek out cancer centers that offer clinical trials early in their treatment journey. This proactive approach is essential for advancing our understanding of this disease and developing more effective therapies.
To explore treatment options and clinical trials, patients and caregivers can request an appointment at MD Anderson online or by calling 1-877-632-6789.
