Cancer Treatment

Intrapleural chemotherapy

Intrapleural chemotherapy is given through large or small chest catheters that may be connected to an implantable port. These catheters can be used to give drugs as well as to drain fluid that often accumulates in the pleural or peritoneal cavity when cancer has spread to these areas. Malignant pleural effusion (MPE) is a common and life-threatening problem in patients with advanced malignancies. In most cases, MPE is controlled by tube drainage combined with pleurodesis and the intrapleural instillation of various sclerosing or chemotherapeutic agents. Most reports on intrapleural chemotherapy are dated and consist of case reports and case series. There are no propective studies and it is not known how it performs aganst pleurodysis or systemic chemotherapy alone.

Erasmus, Jeremy J. MD; Patz, Edward F. Jr MD Treatment of malignant pleural effusions. Current Opinion in Pulmonary Medicine. 5(4):250, July 1999.

Tan, A. Sedrakyan, J. Browne, S. Swift, and T. Treasure
The evidence on the effectiveness of management for malignant pleural effusion: a systematic review.
Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 829 - 838.

Chemotherapy for mesothelioma gemcitabine and oxaliplatin

Lay Summary: Gemcitabine and oxaliplatin combination is promising but needs more study for mesothelioma.

Most patients with malignant mesothelioma are candidates for systemic chemotherapy during the course of their disease, but no standard regimen has been established. Several phase II single-agent and combination chemotherapy studies have been performed over the past two decades. There are tow studies of the gemcitabine/ oxaliplatin combination to my knowledge, a retropsective revieew and two phase II studies, with small numbers of patients.  Although the true impact of chemotherapy in mesothelioma remains to be determined, agents with consistent antitumor activity include the platinum agents and the antifolates.  Recent data from a large randomized phase III clinical trial established the superiority of cisplatin/pemetrexed compared to cisplatin alone.

Pasi A. Jänne First-Line Chemotherapy for Malignant Pleural Mesothelioma in
Malignant Mesothelioma
Advances in Pathogenesis, Diagnosis, and Translational Therapies , 2006
ed. Harvey I. Pass, Nicholas J. Vogelzang and Michele Carbone

M. S. Boyar, M. Hesdorffer, R. N. Taub Phase II trial of oxaliplatin and gemcitabine in patients with malignant pleural or peritoneal mesotheliomaJournal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I. Vol 24, No. 18S (June 20 Supplement), 2006: 17133