First PITAC Procedure for Mesothelioma Performed in North America

A thoracic surgeon has performed the first pressurized intrathoracic aerosol chemotherapy (PITAC) procedure for mesothelioma in North America, marking a milestone for a technique developed in Europe over the past decade. The minimally invasive approach delivers chemotherapy as a pressurized mist directly into the pleural cavity, targeting malignant fluid buildup and tumor tissue while minimizing the systemic toxicity associated with intravenous chemotherapy.

How PITAC Works

The procedure is performed through video-assisted thoracoscopic surgery (VATS), using small incisions and camera guidance. Once access to the pleural cavity is established, carbon dioxide is introduced at 12 mmHg of pressure to create a controlled environment. A chemotherapy solution, typically cisplatin combined with doxorubicin, is then nebulized into the space over approximately five minutes.

The pressurized aerosol remains in contact with the pleural surfaces for 30 minutes, allowing the drug to penetrate tumor tissue more effectively than traditional lavage techniques. The pressure gradient enhances drug absorption while keeping doses low enough to avoid the nausea, immune suppression, and organ damage commonly associated with systemic chemotherapy.

No chest tube is routinely required after the procedure, and patients can typically return home the same day.

What Early Data Shows

PITAC was first performed in 2012 in Herne, Germany, developed alongside PIPAC (pressurized intraperitoneal aerosol chemotherapy), which targets abdominal cancers. A retrospective analysis of the earliest cases, published in PMC, examined five patients who received a combined 11 planned PITAC treatments between 2018 and 2021.

The results, while preliminary, showed measurable responses:

• One patient achieved stable disease for 11 months
• One patient’s malignant pleural effusion resolved with no recurrence at four weeks
• Histological examination showed treatment responses in pleural tissue samples
• Nine of 11 planned treatments were completed without major complications

The patients in this initial cohort had pleural disease from multiple cancer types, including mesothelioma, rectal cancer, breast cancer, and ovarian cancer. No serious adverse events were reported.

Why It Matters for People With Mesothelioma

Malignant pleural effusions, the buildup of fluid between the lung and chest wall caused by cancer, affect a significant proportion of people with pleural mesothelioma. The fluid causes shortness of breath, chest pain, and reduced quality of life. Current management options include draining the fluid, pleurodesis (sealing the space to prevent re-accumulation), or indwelling catheters.

PITAC offers a potential alternative that addresses both the fluid and the underlying tumor. By delivering chemotherapy directly to the affected surfaces, it could reduce effusions while simultaneously treating the cancer cells causing them.

For people with mesothelioma who cannot tolerate aggressive surgery or systemic chemotherapy, a low-toxicity procedure that can be repeated at regular intervals represents a meaningful expansion of treatment options.

The Path Forward

A Phase I clinical trial (NCT06421610), approved in May 2023 at the Odense PIPAC Center in Denmark, is currently recruiting up to 20 patients with malignant pleural effusions. The trial is evaluating PITAC’s safety, toxicity profile, effect on effusion volume, pain levels, breathlessness, and quality of life. Participants receive at least two PITAC sessions at four-week intervals.

No North American clinical trials specifically evaluating PITAC for mesothelioma have been announced as of early 2026. The first North American procedure represents a step toward broader adoption, but routine clinical use will require data from prospective trials demonstrating both safety and efficacy in larger patient populations.

The technique builds on the success of HIPEC, which has become an established treatment for peritoneal mesothelioma. Where HIPEC delivers heated chemotherapy during open abdominal surgery, PITAC achieves a similar targeted delivery in the chest through a minimally invasive approach.