A narrative review of hyperthermic intrathoracic chemotherapy for advanced lung cancer

Abstract

The traditional treatment of stage IV lung cancer is predominantly supportive or palliative. No current standardized guidelines promote the use of hyperthermic intrathoracic chemotherapy (HITHOC) in the treatment of advanced lung cancer with pleural involvement. Several small studies have examined the safety and utilization of HITHOC for this population, though the data is extremely limited. A review of the literature is presented in accordance with the Narrative Review checklist. The MEDLINE electronic database was searched for articles published in English from January 1999 -August 2020 using relevant keywords such as "hyperthermic intrathoracic chemotherapy", "hyperthermic intrapleural chemotherapy" and "HITHOC". This was supplemented by review and hand search of the reference lists. While data suggest a potential though controversial role for HITHOC for certain intrathoracic tumors such as malignant pleural mesothelioma and thymoma, there is insufficient evidence to confidently promote a role for hyperthermic intrathoracic chemotherapy in the treatment of advanced lung cancers. Existing studies are small, nonrandomized, and prone to bias. Hyperthermic intrathoracic chemotherapy is not a standardized treatment for advanced lung cancer, and is characterized by potentially serious side effects with little clinical benefit. Recent developments in targeted therapy and immunotherapy are unlikely to leave room for the development of large randomized controlled trials.

Association between clinical outcomes and local treatment in stage IV non‐small cell lung cancer patients with single extrathoracic metastasis

“…Not only distant metastatic lesions, but other factors such as concurrent intrathoracic metastatic lesion should also be considered. Recent studies show diverse clinical approaches in advanced NSCLC such as primary tumor resection, hyperthermic intrathoracic chemotherapy in patients with malignant pleural effusion, [50][51][52] and future studies that take various host and tumor-related factors into account are vital.…”

Intrapleural Anticancer Therapy for Malignant Pleural Diseases: Facts or Fiction?

“…In addition to the local antitumor effects, these agents can also cause pleurisy, pleural adhesions, and pleurodesis, thus reducing the likelihood of pleural effusion recurrence. 11 Other agents that have been studied include carboplatin and bleomycin, with some investigators also combining multiple chemotherapeutic agents to enhance treatment effects due to synergistic effects of the drugs. In a large meta-analysis that accumulated data from 13 randomized controlled trials, authors demonstrated that the combination of endostatin (a novel recombinant human endostatin that blocks vascular endothelial growth factor [VEGF]) with chemotherapy showed a better overall response rate (ORR) that chemotherapy alone in patients with malignant pleural effusions secondary metastatic cancer (breast, lung, digestive tract).…”

“…10 The most commonly studied agent has been cisplatin as an intraoperative adjuvant therapy in malignant pleural mesothelioma. 11 The rationale for this approach is the ability to deliver cytotoxic agents in concentrated doses locally with reduced systemic absorption and toxicity. In addition to the local antitumor effects, these agents can also cause pleurisy, pleural adhesions, and pleurodesis, thus reducing the likelihood of pleural effusion recurrence.…”

Hyperthermic intrathoracic extracorporeal chemotherapy for secondary malignant pleural disease

“…Advancement in targeted therapy and immunotherapy may eliminate the need for P/D and HITEC altogether for Stage IV NSCLC with PD only in the future. 27 Aggressive trimodality treatment approach has been evaluated in patients with secondary pleural metastasis. 15,16 This combination has been effective in achieving local control and improved 5-and 10-year survivals in selected patients with metastatic thymic malignancies.…”