Twice as Effective? Pressurized Intra-Thoracic Aerosol Chemotherapy: New Frontiers in Pleural Mesothelioma

Our plain-English summary of Twice as Effective? Pressurized Intra-Thoracic Aerosol Chemotherapy: New Frontiers in Pleural Mesothelioma, by M.G. Mastromarino, E. Guerrini, R. Guerrieri, et al (Medical Sciences, 2025).

The study

• Authors: M.G. Mastromarino, E. Guerrini, R. Guerrieri, G. Elia, A. Lenzini, V. Aprile, G. Alì, S. Korasidis, M.C. Ambrogi, M. Lucchi
• Journal: Medical Sciences
• Published: 2025;13(2)
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pressurized intra-thoracic aerosol chemotherapy (PITAC) is a novel and promising strategy for the treatment of malignant pleural effusion (MPE). PITAC enables effective pleurodesis while potentially exerting an antineoplastic effect by delivering chemotherapeutic agents as a therapeutic aerosol into the thoracic cavity via a nebulizer. Our preliminary study involved nine patients with unresectable pleural mesothelioma (PM) treated with PITAC. Among them, one case was particularly emblematic for demonstrating notable oncological improvements in addition to well-known palliative benefits. This patient underwent two PITAC procedures, one year apart, without perioperative complications. Redo pleural biopsies from both previous and new sites revealed only fibrous tissue and inflammatory cells, with no evidence of malignancy. Beyond achieving pleurodesis, PITAC-by combining cytotoxic and sclerosing effects-may offer effective local antineoplastic control and represent a promising avenue for enhancing loco-regional therapy in PM.

In plain English

This was a small pilot study from the University Hospital of Pisa, Italy, with no comparison group. From January 2022 to December 2024, nine patients had pleural mesothelioma that could not be removed surgically and fluid build-up around the lung (malignant pleural effusion). They received pressurized intra-thoracic aerosol chemotherapy (PITAC): cisplatin and doxorubicin sprayed as a pressurized mist into the chest cavity during thoracoscopy under general anesthesia. Six of the nine had occupational exposure to asbestos; no fiber types were reported. Eleven procedures were performed. There were no complications during or after surgery and no deaths within 30 days. The fluid had not returned at one month in all nine patients, and at six months in seven. The authors highlighted one 79-year-old man, previously treated for peritoneal mesothelioma, whose first biopsies showed mesothelioma in situ. After the fluid returned, he had a second procedure a year later. Its biopsies showed no cancer, only inflammation and fibrosis. The authors concluded that PITAC appeared feasible and safe, with potential efficacy. They cautioned that evidence from a single case is anecdotal and that larger studies are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Pilot study (single-arm, no control group), with a detailed description of one patient's case
• Who was studied: Nine patients with unresectable pleural mesothelioma and malignant pleural effusion, treated at the University Hospital of Pisa, Italy, January 2022 to December 2024. Eight were male and one female, with a median age of 74. Six of the nine had occupational exposure to asbestos.
• Exposure: The study examined a treatment, not an asbestos exposure: PITAC with cisplatin (10.5 mg per square metre of body surface in 150 mL saline) and doxorubicin (2.1 mg per square metre in 50 mL saline), aerosolized into the pleural cavity. Occupational asbestos exposure was recorded for 6 of the 9 patients; fiber types were not given.
• Main results:
  • Eleven PITAC procedures were performed in the nine patients; two patients had a second PITAC.
  • Among all patients, there were no intraoperative or postoperative complications and no 30-day mortality.
  • Effective pleurodesis was reported in all nine patients at one month, and was sustained beyond six months in seven patients.
  • In the index case, a 79-year-old man previously treated for peritoneal mesothelioma, the first PITAC biopsies confirmed mesothelioma in situ.
  • In the index case, the first PITAC achieved pleurodesis and local disease control for nine months. No systemic chemotherapy was given because of renal insufficiency.
  • In the index case, biopsies at the second PITAC, taken from the previously marked sites and at least three additional pleural areas, showed no evidence of malignancy.
  • In the index case, CT at one-year follow-up after the second PITAC showed no recurrence of pleural effusion.
  • Of the four other patients tested for BAP1, three also showed BAP1 loss but did not have the same degree of response as the index case.
• The authors' conclusion: The authors concluded that their preliminary findings showed PITAC was feasible and safe, with potential efficacy, in unresectable pleural mesothelioma, and that prospective trials are needed to validate it.
• Limitations the authors state:
  • Small number of patients from a single institution, limiting generalizability
  • No control group, so no direct comparison with standard therapies
  • Long-term oncological outcomes were not assessed
  • The tumor-response evidence comes from a single case and is anecdotal
  • No direct evaluation of inflammatory or fibrotic markers was performed
  • BAP1 status was assessed in only a subset of patients

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Chemotherapy, Pleural Mesothelioma, Pleural Effusion, Pleurodesis, Unresectable Pleural Mesothelioma, Palliative Care.

Related studies

• Oxaliplatin use in pressurized intraperitoneal aerosol chemotherapy (PIPAC) is safe and effective: A multicenter study — O. Sgarbura, M. Hübner, et al. (2019)
• Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) — K. Odendahl, W. Solass, et al. (2015)
• Multicentric initial experience with the use of the pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the management of unresectable peritoneal carcinomatosis — M. Alyami, J. Gagniere, et al. (2017)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for the treatment of malignant mesothelioma — U. Giger-Pabst, C. Demtröder, et al. (2018)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)

Browse return to medical research.