MPeM (Malignant Peritoneal Mesothelioma) usually follows the same treatment as pleural mesothelioma, a cancer of the lung lining, although there are significant differences between the diseases. MPeM is far rarer, understudied, has a weaker association with asbestos exposure, affects women more frequently, occurs at a younger age and is diagnosed more often at an advanced stage. Treatment strategies are varied, but usually include optimal cytoreductive surgery, hypothermic intraoperative peritoneal perfusion with chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC). Patients with MPeM usually are treated following the recommendations for malignant pleural mesothelioma and most studies on chemotherapy drugs have been done for pleural mesothelioma, often excluding MPeM patients. The National Comprehensive Cancer Network (NCCN) recommends first-line platinum chemotherapy for both mesotheliomas, but after disease progression there is no established treatment strategy or any Food and Drug Administration-approved treatments for advanced MPeM. A single-center study has been carried out for evaluation of atezolizumab and bevacizumab in a variety of advanced cancers. Atezolizumab is a type of immunotherapy drug called an immune checkpoint inhibitor that targets PD-L1, while bevacizumab is a targeted therapy that slows the growth of new blood vessels by inhibiting vascular endothelial growth factor (VEGF). This publication reports data for the 20 patients in the MPeM cohort. The median age was 63 years, 60% of participants were women and 75% self-reported that they had not been exposed to asbestos. Trial participants were 80% white, 10% Hispanic, 5% Black and 5% other. Progression-free and overall survival at one year were 61% and 85%, respectively. The treatment was well-tolerated, with the most common events being hypertension and anemia. Patients treated on this regimen surpassed outcomes expected with conventional therapies. This data shows that this is a reasonable treatment option and reiterates the importance of clinical trials for rare cancers to extend patient survival. |