Long-term survival in peritoneal mesothelioma treated with 24 consecutive PIPACs.

Objectives: Malignant peritoneal mesothelioma (MPM) is a rare disease with unspecific abdominal symptoms which is therefore often diagnosed at an advanced stage. Curative therapy is delivered by radical surgery, whereas palliative therapy consists of systemic chemotherapy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopically applied chemotherapy which was invented to administer high doses of chemotherapy intraperitoneally in palliative cases of peritoneal malignancies. Methods: The case of a male patient who received PIPAC treatment as individualized approach for unresectable malignant peritoneal mesothelioma is reported. Results: The patient began treatment with PIPAC procedures in 2017 for MPM that was unresectable because of extensive disease on the small bowel and refused systemic chemotherapy as the usual standard of care. We initiated PIPAC with doxorubicin and cisplatin and could reach stable disease within one year of treatment so that the therapy was discontinued for 2.5 years. Due to progressive disease, PIPAC was continued resulting in stable disease for 2 years. In total, the patient received 24 PIPAC procedures with no major surgical or toxic side effects over seven years timespan. Conclusions: We report the case of a patient with MPM who could reach long-term survival of seven years due to a total of 24 PIPAC procedures.