Malignant Primary peritoneal Mesothelioma .pptx

CRS-HIPEC in MPPM

1. General treatment principles and systemic treatment options for CRS-HIPEC ineligible patients Dr.Sandeep Gedela SR3, Medical Oncology Tata Memorial Hospital

2. General principles of treatment : Treatment options for diffuse PeM include surgery and/or systemic therapy. Select patients with medically operable diffuse PeM and good PS are candidates for multimodality therapy including those with Epitheloid histology and unicavitary disease. Systemic therapy is recommended for patients with diffuse PeM who are not eligible for or refuse surgery. Best supportive care is recommended for patients with a PS of 3-4. Radiation therapy is not recommended as primary therapy but can be used for palliation. No phase 3 RCT to determine the best treatment option because of the rarity of the disease but PeM and pleural mesothelioma being similar, systemic chemotherapy recommendations are largely based on extrapolation from clinical trials of pleural mesothelioma.

3. Systemic therapy for patients ineligible for surgery: Indications for systemic therapy: Medically inoperable Complete cytoreduction not feasible Presence of ANY high-risk features

4. High risk features requiring systemic therapy: Biphasic/sarcomatoid histology Nodal metastasis Ki-67 >9% Thrombocytosis PS-2 Bicavitary disease High disease burden/incomplete cytoreduction (PCI >17) Completeness of cytoreduction (CC) score >1

5. High risk features requiring systemic therapy: Biphasic/sarcomatoid histology Nodal metastasis Ki-67 >9% Thrombocytosis PS-2 Bicavitary disease High disease burden/incomplete cytoreduction (PCI >17) Completeness of cytoreduction (CC) score >1

6. Pemetrexed+Platinum in Inoperable PeM : from EAP

7. Immunotherapy in MPeM

8. Subsequent lines of therapy in Inoperable PeM

9. Gemcitabine+Cisplatin 1L therapy in Inoperable PeM

10. Gemcitabine+Paclitaxel 1L therapy in Inoperable PeM

11. ICI+VEGFi 2L therapy in Inoperable PeM

12. Immunotherapy in Subsequent Line : CONFIRM Trial

13. Immunotherapy in Subsequent Line : CONFIRM Trial

14. Immunotherapy in Subsequent Line : CONFIRM Trial

15. Systemic therapy for Inoperable MPeM

16. Thank You