When Gary Green started experiencing chest pain in 2014, he tried to push aside the lingering fear that it could be cancer. He spent four decades working jobs that exposed him to asbestos, a mineral that can cause mesothelioma. It is an aggressive form of cancer that can occur in the tissue that lines the lungs, abdomen or heart.

When a biopsy confirmed the diagnosis, doctors gave Green five months to live and referred him to Moffitt Cancer Center. He started treatment, but when chemotherapy and two immunotherapy clinical trials failed to work, Green was out of options.

“They said there was nothing else they could do for me besides refer me to hospice,” said Green.

Because mesothelioma is such a rare and understudied disease, it has fewer treatment options compared to other cancer types. Surgery is the only true chance for a cure, but less than 20% of patients are candidates for surgery. If a patient fails or has progressive disease after initial chemotherapy treatment, there is no approved second option.

“Pretty much every patient who has inoperable disease will eventually develop progressive disease, and at that point, we have limited options,” said Dr. Tawee Tanvetyanon, a medical oncologist in the Thoracic Oncology Program at Moffitt.

However, there is now hope for those patients.

As Green was walking out of Moffitt that last day, he heard his name being paged on the intercom. His team found him one last option: a first of its kind clinical trial for a procedure called transarterial chemoperfusion therapy.

Unlike traditional chemotherapy, the treatment delivers a high concentration of drugs to the diseased tissue lining the lungs. During the procedure, a chemotherapy cocktail is injected into the arteries that are supplying the tumor. It is an outpatient procedure that takes about one hour followed by one hour of recovery, and the treatment is administered once every four weeks.

“Most of the patients have minimal side effects,” said Dr. Bela Kis, co-section head of the Interventional Radiology Program, who designed the chemoperfusion treatment protocol. “The most commonly recorded side effects are minimal chest pain during the drug injection and mild nausea after the procedure.”

Green says he experiences weakness and mild nausea in the few days after treatment, but both are manageable. On the trial for more than three years, he just completed his 40^th treatment. He no longer is suffering from severe chest pain and shortness of breath, and his quality of life has dramatically improved. He is very involved in his church and enjoys doing activities again with his wife.

“The procedure is easy and I have had zero complications,” said Green. “It’s pretty incredible, I didn’t think I would even be here still.”

Moffitt is the only cancer center offering transarterial chemoperfusion to mesothelioma patients, and the results of the study were selected as the Abstract of the Year at the 2020 Society of Interventional Radiology Meeting. The trial has enrolled 27 patients who have previously received chemotherapy and continued to have disease progression. The results showed a 70.3% disease control rate and a median overall survival rate of more than eight months from the start of treatment.

Kis says the next steps are to explore increasing dosage and changing the combination of medications to determine if it could further improve outcomes. He also hopes to one day expand the study to other cancer centers to help as many mesothelioma patients as possible. 

“So far, we have been able to increase survival and improve patients’ lives with this treatment,” said Kis. “I am excited for the future.”

For more information on the clinical trial, click here.