Mesothelioma and New Comprehensive Approach of Cytoreductive Surgery

Another interesting study entitled "Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy" by
. Tristan D. Yan MD, NAMIC Haverić Dr. Carlos P. Carmignani Dr. David Chang MS, Paul H. Sugarbaker, MD - Cancer Volume 103, Number 4, pages 839-849, 15 February 2005 Here's an excerpt: "Summary - Background - Malignant peritoneal mesothelioma is a rare and fatal disease, until recently, treatment options were very limited and ineffective new comprehensive approach to cytoreductive surgery with perioperative intraperitoneal chemotherapy has improved survival rates for the cost of considerable morbidity and mortality as .. in other peritoneal surface malignancies. the outcome after these treatments is mainly dependent on adequate cytoreduction. The aim of this study was to determine the computed tomography (CT) scan images that are useful in patient selection for this comprehensive approach.

methods - Analysis of preoperative CT of 30 patients with peritoneal mesothelioma treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy in one institution was performed. Based on the size of the tumor nodules remaining after cytoreductive surgery, patients were divided into 2 groups: those with residual lesions ≤ 2.5 cm (corresponding cytoreduction) and those with the rest of the lesions> 2.5 cm (suboptimal cytoreduction). CT for each patient were evaluated by a standardized scoring system with a copious reader operative findings. Thirty-nine CT parameters were obtained and statistically analyzed to determine their association with variables, test results, or adequacy of cytoreduction.

RESULTS - Seven patients (64%) in suboptimal cytoreduction group and 2 patients (11%) in the corresponding cytoreduction group had a> 5-cm tumor mass in the epigastric region (P = 0.004). Nine patients (82%) in group 2 patients and suboptimal (11%) in the corresponding groups of cytoreduction is the CT scan which showed a loss of normal architecture of the small bowel and mesentery (P <0.001). In a complex analysis of the two radiological features, none of the patients with> 5-cm tumor mass in the epigastric region and loss of normal architecture of the small intestine and mesentery had an adequate cytoreduction. Patients who did not have these two preoperative CT findings of a 94% probability of adequate cytoreduction.

CONCLUSIONS - CT effectively identified a peritoneal mesothelioma tumor at key anatomical sites. Because adequate cytoreduction is necessary to achieve prolonged survival, CT has become an accurate prognostic radiologic test for patient selection for comprehensive treatment.

CONCLUSIONS - CT effectively identified a peritoneal mesothelioma tumor at key anatomical sites. Because adequate cytoreduction is necessary to achieve prolonged survival, CT has become an accurate prognostic radiologic test for patient selection for comprehensive treatment.

Another interesting study called "anti-tumor activity of K1-LysPE38QQR, Immunotoxin targeting mesothelin, Cell-surface antigen expressed in ovarian cancer and malignant mesothelioma" by Hassan, Raffit, Viner, Jaye L Wang, Qing-Cheng, Margulies, Inger, Kreitman, Robert J, Pastan, Ira - Journal Immunotherapy:
. July / August 2000 - Volume 23 - Issue 4 - pp 473-479 Here is an excerpt: "Abstract - mesothelin, a differentiation antigen, is a 40 KD glycosylphosphatidylinositol-linked cell surface glycoprotein that is present on the surface of normal mesothelium and is expressed in many patients with epithelial ovarian cancer and malignant mesotheliomas. monoclonal antibody K1 is a murine immunoglobulin G1 that recognizes mesothelin. LysPE38QQR the truncated form of Pseudomonas Exotoxin no cell binding domain, but retains the expulsion and adenosine diphosphate-ribosylation domain. This is a lysine residue near the amino end of the available for conjugation to antibodies. to prevent chemical conjugation of antibody to lysine residues in the C-terminus of Pseudomonas Exotoxin, two lysine residues at positions 590 and 606 were mutated to glutamine, lysine and the rest at position 613 was mutated to arginine. monoclonal antibody K1 was chemically conjugated with LysPE38QQR, modifying the antibody with sulfo-succinimidyl-4-(N-maleimidomethyl) cyclohexane-1-carboxylate and coupling with SPDP N-succinimidyl 3 -. (2-pyridyldithio) propionate-modified LysPE38QQR result immunotoxin K1-LysPE38QQR is highly toxic to A431-K5 cells (human epidermoid carcinoma cell line transfected with a mesothelin expression plasmid) with half-maximal inhibitory concentration of 3-6 ng / ml. immunotoxin has negligible activity against A431 cells, which do not express mesothelin (median inhibitory concentration> 100 ng / mL). This immunotoxin also caused complete regression of tumors in nude mice that received xenografts of mesothelin-positive human cancers. These results show that immunotoxins directed against mesothelin are a therapeutic option that deserves further investigation for the treatment of ovarian cancer and malignant mesotheliomas. "