Pseudomyxoma peritonei medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

The predominant therapy for pseudomyxoma peritonei is surgical resection. Supportive therapy for pseudomyxoma peritonei includes chemotherapy. Chemotherapy is infused directly into the abdominal cavity to kill cancerous cells.

Medical Therapy

• The effect of systemic chemotherapy in pseudomyxoma peritonei seems questionable.
• Jones et al reported their experience in the treatment of pseudomyxoma peritonei of ovarian origin with cisplatinum, doxorubicin, and cyclophosphamide, with excellent responses.
• On the other hand, Smeenk et al reported the poor response of six patients (3 patients with DPAM, another 3 patients with PMCA-I, and all 6 patients with lesions diffusely spread throughout the abdomen) after 5-FU based systemic chemotherapy, and subsequent poor prognosis was noted in the study.
• Regarding the benefit of new therapeutic agents (including Capecitabine, Oxaliplatin, Irinotecan and Bevacizumab) and modern schedules for patients with metastatic CRC, clinical experience with the use of these agents for pseudomyxoma peritonei are still absent, and it is questionable whether they will do any better in this situation, especially for patients with PMCA.
• Due to the limited experience and indeterminate effects of systemic chemotherapy in pseudomyxoma peritonei, some studies still suggest that systemic therapy should be reserved for a palliative setting in patients with recurrent or progressive disease
• Chemotherapy is infused directly into the abdominal cavity to kill remaining cancerous cells.
• The drugs may be manually applied to the cavity for an hour or two as the last step in the surgery, or ports are installed to allow circulation and/or drainage of the chemicals for one to five days after surgery.
• Cancer cells reproduce quickly on scar tissue, and there is lots of scar tissue after surgery.
• Even with aggressive, heated chemotherapy treatment pseudomyxoma peritonei recurrence is common and further surgeries are frequently needed.
• Patients often require frequent CT scans for a period of time to spot any tumor regrowth.
• Oral and intravenous chemotherapy has become more commonly used during the past five years. In cases in patients have experienced stability in tumor growth through treatment with various systemic chemotherapies.
• Additionally recent (2003) publications linking the MUC2 enzyme overexpression to Pseudomyxoma cell reproduction has launched research efforts into additional drug treatments.

References

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