NCI HIPEC Phase 2 Trial (NCT05001880)

No medical treatment, including surgery, can remove asbestos fibers from the lungs once inhaled. These fibers remain embedded in lung tissue, causing irreversible scarring in asbestosis, with treatments focusing on symptom relief and disease progression management. For people with mesothelioma, surgery such as extrapleural pneumonectomy or pleurectomy/decortication aims to remove tumors from the pleura or chest lining, but it cannot address the underlying asbestos fibers and is limited to early-stage cases based on location and health. Long-term outcomes from aggressive surgeries like extrapleural pneumonectomy do not support routine use.

People with peritoneal mesothelioma have an average life expectancy of 53 months with cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC), compared to 6-12 months without treatment. The 5-year survival rate is 65%, rising to about 80% with cytoreduction, HIPEC, and follow-up chemotherapy in eligible cases. Survival varies by cell type, with epithelioid averaging over 31 months and sarcomatoid around 5 months after treatment.

Mesothelioma is a rare cancer caused by asbestos exposure, primarily affecting the mesothelium lining the lungs (pleura), abdomen (peritoneum), heart (pericardium), or testes. Asbestos fibers inhaled or ingested lodge in these tissues, causing chronic inflammation and DNA mutations that lead to cancer over decades. Pleural mesothelioma accounts for 80% of cases, peritoneal for 20%, and pericardial or testicular types for less than 1%.

The latency period for mesothelioma, defined as the time from initial asbestos exposure to diagnosis, typically ranges from 10 to 60 years, with a median of about 34 years. Studies report mean latencies of 33.7 years in a South Korean cohort of 923 people with malignant mesothelioma and 22.8 years overall, though many people with mesothelioma experience symptoms 30 to 50 years post-exposure. Factors like exposure intensity, duration, asbestos type, age at exposure, and genetics influence this period, with higher or occupational exposures often linked to shorter latencies. Rare cases manifest in under 10 years or over 70 years.

For some people with cancer limited to the lining of the abdomen, HIPEC has been associated with better survival than traditional chemotherapy alone, especially when surgeons can remove most or all visible disease. HIPEC also delivers chemotherapy directly to the abdomen, which can mean higher local drug levels and fewer whole-body side effects than IV chemotherapy. But the evidence is not uniform across all cancers, and some studies have found no overall survival advantage, even though toxicity was lower. So HIPEC is not broadly better in every situation, but it can be more effective for carefully selected people with peritoneal disease.

Evidence from large series shows that combined cytoreductive surgery and HIPEC is a major operation with reported overall complication (morbidity) rates around 30% to 70% and treatment‑related death (mortality) in roughly 0% to 18%, depending on cancer type, disease extent, and center experience. Common issues include abdominal pain, fatigue, digestive changes, low blood counts, infections, bleeding, and slower return of bowel function, while more serious but less common problems include blood clots, anastomotic leaks, organ injury, and pneumonia. HIPEC also carries specific risks from heated chemotherapy such as temporary kidney strain, fluid and electrolyte imbalance, and hematologic toxicity, which some studies describe in 4% to 39% of people. Long‑term risks can include scar tissue (adhesions) that cause chronic abdominal pain or bowel problems, and there remains a risk of cancer recurrence despite treatment. Outcomes and safety reported in the literature are generally better in high‑volume centers using strict protocols and in people with limited disease and good overall health.

HIPEC surgery occurs under general anesthesia, so people with mesothelioma feel no pain during the procedure. Postoperatively, people experience abdominal pain or discomfort, often described as soreness, tightness, or pressure that peaks in the first few days and improves with medication such as opioids, NSAIDs, or nerve blocks. Pain levels vary by surgery extent, cancer type, and individual tolerance, but sources report it as manageable and temporary with medical team support. Common side effects include fatigue, nausea, and bowel changes alongside pain.