Pleural mesothelioma, caused by exposure to asbestos is a rare cancer – only 3,000 cases are diagnosed in the U.S. each year – but it is highly aggressive. There is no cure for plural mesothelioma but findings published in the Journal of Thoracic and Cardiovascular Surgery reveal that a new type of combination treatment specifically applied to tumors after surgery may help increase overall survival.
Over the years, treatments have advanced but the most common drug used for pleural mesothelioma is cisplatin. This treatment is typically used in combination with pemetrexed, given intravenously before surgery. After surgery, cisplatin can then be applied as a heated chemotherapy directly to the infected area. This method of administering the drug has had some positive outcomes and has increased over all survival in the past; however, the heated chemotherapy solution that is applied directed after surgery may negatively affect the kidneys because the body is absorbing the treatment too quickly. Kidney failure has become an unfortunate side effect of this method.
Researchers and scientists from the University Hospital Zurich may have discovered a new technique in directly applying cisplatin after surgery that would shrink the mesothelioma tumors and not induce kidney failure. This new chemotherapy treatment is gel-based and is a combination cisplatin and fibrin, which is a protein essential to blood clotting.
What is Fibrin?
Fibrin is protein produced from fibrinogen, which is found in the liver and blood plasma that forms when blood is clotting. For instance, if one has an open wound, fibrinogen rushes to the wound site and with the help of thrombin, converts to fibrin and coagulates the blood. This allows the wound to seal and heal, and the clogged blood prevents outside bacteria and toxins from getting in and causing an infection. Fibrin was discovered over 350 years ago when Marcello Mapighi, a biologist and physician from Italy, found that red blood cells’ texture was fibrous in nature in cardiac thrombi and in vitro blood clots. Throughout the next few centuries, continued research found fibrin to be essential for hemostasis, healing wounds, preventing infections, and stopping severe bleeding from either surgical procedures or trauma. This “sealant” property of fibrin is what has researchers and scientists hopeful it can be an effective tool in administering cisplatin directly as it can act as a carrier.
The gel-like cisplatin and fibrin solution was applied to mesothelioma tumors in animals. Results from the study showed that once the treatment was administered, it was able to stay in place and not be absorbed so quickly as the heated cisplatin treatment. The solution had high concentrated levels of cisplatin that stayed in the system for up to 70 days after surgery.
Even though this has yet to be tested on human subjects, researchers and scientists are optimistic those clinical trials will show an increase in tumor shrinkage and that the technique could even be used in combination with radiation therapy. Trials will focus on procedure, tolerability to high concentrations of cisplatin, and overall safety.
Optiz, I. et. al “Optimized intrapleural cisplatin chemotherapy with a fibrin carrier after extra pleural pneumonectomy: a preclinical study,” Journal of Thoracic and Cardiovascular Surgery (January 2011.