Treatment of mesothelioma--Chemotherapy

Peritoneal mesothelioma chemotherapy

PMM chemotherapy drug for moderate and sensitive. Preoperative induction chemotherapy, surgery and postoperative adjuvant chemotherapy could reduce tumor recurrence and improve 3-year survival rate.

PMM effect of the treatment of certain chemical drugs doxorubicin, cisplatin and carboplatin, bleomycin and domestic anti-cancer drug Elemene and so on. Long
The new spring base, fluorouracil, cyclophosphamide, mitomycin C, also worth a try.

Doxorubicin (Adriamycin, ADM) for each adult 30 ~ 60mg/m2, every 3 weeks 1, or intravenous injection, with a total dose of no more than
550mg/m2. Adverse reactions to toxic to the heart, and have accumulated, with the total dose-related; followed by bone marrow suppression, gastrointestinal reactions and hair loss, and so on.

Cisplatin (Cisplatin, DDP, cisplatin) for each adult 80 ~ 120mg/m2, every 3 weeks 1; or 20mg/m2, MS 5 days every 3 weeks
A course of treatment, intravenous injection. There are side effects of renal toxicity, ototoxicity, neurotoxicity, gastrointestinal reactions and bone marrow suppression, and so on. Mannitol can be used to increase
Reduce its accumulation in renal tubular. The drug is also used in intra-abdominal injection, the specific methods below.

Carboplatin (Carboplatin, CBP) for each adult 300 ~ 400mg/m2, 5% glucose or saline solution, to dilute the concentration of
0.5mg/ml of the solution, intravenous drip, every 3 to 4 weeks to repeat; or 100mg / d, 5% glucose solution in 500ml intravenous drip, MS 5 days;
3 to 4 weeks at a repeat. Can also be used for each 300 ~ 500mg intraperitoneal injection once a week.

Bleomycin (Bleomycin, BLM) with adults 15 ~ 30mg, dissolved in saline or 5% of the amount of glucose solution in the deep intramuscular injection, intravenous
Intravenous drip or twice a week; can be changed according to circumstances 1 / d or several times a week. 60mg can also use dissolved into the abdominal cavity slow. Stey with BLM
Intra-abdominal injection, 1 case of the treatment of patients with PMM, the results of the ascites disappeared after the drug did not appear to survive for more than 3 years. However, BLM high-dose intra-abdominal injection
Which can cause pneumonia-like symptoms and even pulmonary fibrosis; In addition, fever, gastrointestinal reactions more common, allergy occurred in individual patients.

Taxol (Paclitaxel) of the goods is extracted from the bark of the yew anti-cancer drug, through the induction and promotion of tubulin polymerization, to prevent the solution
Poly and stability of microtubules, inhibit cell proliferation and mitosis. Taxol can inhibit mitotic microtubule network required for regeneration, prevent mitosis
Spindle lead to the formation of the chromosomes break inhibit the replication of tumor cells. Dose of 135 ~ 175 mg/m2, diluted in normal saline or 5%
Intravenous glucose solution. Repeat every 3 weeks. 12 hours before the medication should be given dexamethasone 20 mg, 30 ~ 60 minutes ago should intravenous diphenhydramine
50 mg and 300 mg cimetidine or ranitidine 200 mg, to prevent allergic reactions. Combined with cisplatin for approximately 66.7 percent of the patients effectively and in tolerance
Its toxicity [6]. There are side effects of bone marrow suppression, allergic reactions, arthralgia, myalgia, gastrointestinal reactions, peripheral neuropathy, syncope, a total of
Economic dislocation and pain at the injection site, and so on.
Elemene (Elemene) for traditional Chinese medicine Ezhu to extract the anticancer substances; chest, abdomen infusion in the treatment of malignant chest, the better ascites
Effect. In addition to pumping as much as possible in the ascites, according to the amount of 200 ~ 400mg/m2 into the abdominal cavity, 1-2 times a week. The incidence of adverse reactions was 20% to 70%, the main
To have fever, chills and pain; such as pre-anesthetic and inject a small amount of hormones, it can prevent it; other allergic reactions, gastrointestinal reactions.

Cyclophosphamide (CTX) for each adult 600 ~ 1200mg, each week one or two, intravenous injection. After the treatment of bone marrow suppression, gastrointestinal reactions
Bleeding and bladder go far higher than common adverse reactions.

Vincristine (VCR) for each adult 2.5 ~ 8mg/m2, at 1 week, intravenous injection, the total amount of 60 ~ 80mg, the main side effect
For bone marrow suppression.

Methotrexate (MTX) for each adult 15 ~ 50mg, a week one or two, muscle or intravenous injection. There are side effects of bone marrow suppression, gastrointestinal reactions,
Stomatitis, liver and kidney dysfunction, and so on, the long-term drug use may be caused by pulmonary fibrosis.

There are two types of chemotherapy.

Systemic chemotherapy given to anti-cancer drug, the peritoneal cavity less drug distribution. Foreign reports, whether single or combination drug, there are systemic chemotherapy
Efficiency 11% to 14%. Combined chemotherapy, including: DDP + ADM, DDP + CTX + VCR, CTX + VCR + BLM, and so on. However, many scholars stressed that the United
And would not improve the efficacy of chemotherapy [11]. Poulain, etc. [12] In vitro studies of the DDP, CBP and amphotericin B (AmB) for malignant mesothelioma cell line of fine
Cell toxicity. Contact the above cell lines to the drug 2 hours, 6 days later growth - inhibition curve shows that the concentration of 5 ~ 10mg / L of the AmB-min
A sense of resistance or the cell line, CBP can make the DDP and 50% growth - inhibitory concentration (IC50) to reduce 5 ~ 10 times. AmB role may be related to significant
An increase of tumor cell uptake of platinum, platinum increased the concentration of cells, the cells increased platinum-related toxicity. Phosphodiesterase inhibition A
Xanthine-based (phosphodiesterase inhibiting methylxanthines) and AmB have synergy, its low toxicity and can ease
AmB of renal toxicity. But so far no clinical drug combination of the above.

In recent years, that intra-abdominal chemotherapy, intra-abdominal injection drug use may increase the local concentration of drug to reduce the systemic side effects; not only the eradication of surgery
After the residual tumor tissue, to reduce the recurrence; may also lose some surgical patients the opportunity to reduce the mass, ascites reduced the disease under control.
Intra-abdominal and intravenous dosage amount of a similar or slightly higher than the latter; repeated after 1 week. Under the condition can be injected a few weeks in a row. Ito [13], and so on
1 to the operation failed to remove the patient PMM injection DDP, and the combination of uracil and tegafur, made an unexpected effect:
In the 223 days after abdominal mass and ascites disappeared. However, in the first 8 months after pelvic tumor recurrence; to give DDP and camptothecin, the result was not good.
Ma, and so on [14] while continuing to use heating abdominal perfusion (continuous hyperthermic peritoneal perfusion, CHPP) combined DDP
Local injection treatment of PPM. The average amount of the initial infusion DDP for 120mg/ml (81 ~ 166mg/ml), perfusion flow 1.5L/min, the average amount of reperfusion
5.1L (4 ~ 7L), reperfusion after 90 minutes, measuring intra-abdominal temperature for 3 41.5 ℃, 40.5 ℃ and 41.1 ℃. DDP curve of the total fluid infusion
Area under (AUC) for plasma DDP AUC's 21 times the plasma concentration of DDP with the body when the drug is similar. The course of treatment had no significant local adverse reactions,
Patients are able to tolerate CHPP. 10-month follow-up, 1 case of non-CHPP as a result of medical treatment. Park, and so on [15] had a similar report. As things stand,
CHPP as good as treatment for the PMM is an effective way.