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Local chemotherapy for neoplastic pericardial effusion

      We read with great interest the report of Bishiniotis et al
      • Bishiniotis T.S.
      • Antoniadou S.
      • Katseas G.
      • Mouratidou D.
      • Litos A.G.
      • Balamoutsos N.
      Malignant cardiac tamponade in women with breast cancer treated by pericardiocentesis and intrapericardial administration of triethylenethiophosphoramide (thiotepa).
      on intrapericardial administration of thiotepa in a selected population of 19 patients with breast cancer and neoplastic pericardial effusion. This article confirms previous reports on the efficacy and tolerability of this drug.
      • Beretta F.
      • Martinelli G.
      • Cavalli F.
      • Marone C.
      Pericardial effusion in patients with malignant neoplasms.
      ,
      • Colleoni M.
      • Martinelli G.
      • Beretta F.
      • Marone C.
      • Gallino A.
      • Fontana M.
      • Graffeo R.
      • Zampino G.
      • De Pas T.
      • Cipolla G.
      • Martinoni C.
      • Goldhirsh A.
      Intracavitary chemotherapy with thiotepa in malignant pericardial effusions an active and well-tolerated regimen.
      The authors suggest thiotepa as first-choice local chemotherapy for malignant pericardial effusion, and state that its systemic absorption is minimal when given intrapericardially, quoting an article published by 2 of us.
      • Figoli F.
      • Zanette M.L.
      • Tirelli U.
      • Sorio R.
      • Lestuzzi C.
      • Urso R.
      • Monfardini S.
      • D’Incalci M.
      Pharmacokinetics of VM26 given intrapericardially or intravenously in patients with malignant pericardial effusion.
      Actually, the article quoted concerned the use of teniposide, a completely different drug (not an alkylating agent). It is possible (and likely) that all the drugs given intrapericardially are minimally absorbed, but this has not yet been proven for thiotepa. Moreover, in the study by Bishiniotis et al, thiotepa was not compared with any one of the many other chemotherapeutic agents available for local therapy.
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      References

        • Bishiniotis T.S.
        • Antoniadou S.
        • Katseas G.
        • Mouratidou D.
        • Litos A.G.
        • Balamoutsos N.
        Malignant cardiac tamponade in women with breast cancer treated by pericardiocentesis and intrapericardial administration of triethylenethiophosphoramide (thiotepa).
        Am J Cardiol. 2000; 86: 362-364
        • Beretta F.
        • Martinelli G.
        • Cavalli F.
        • Marone C.
        Pericardial effusion in patients with malignant neoplasms.
        Schweiz Med Wochenschr. 1992; 122: 1517-1524
        • Colleoni M.
        • Martinelli G.
        • Beretta F.
        • Marone C.
        • Gallino A.
        • Fontana M.
        • Graffeo R.
        • Zampino G.
        • De Pas T.
        • Cipolla G.
        • Martinoni C.
        • Goldhirsh A.
        Intracavitary chemotherapy with thiotepa in malignant pericardial effusions.
        J Clin Oncol. 1998; 16: 2371-2376
        • Figoli F.
        • Zanette M.L.
        • Tirelli U.
        • Sorio R.
        • Lestuzzi C.
        • Urso R.
        • Monfardini S.
        • D’Incalci M.
        Pharmacokinetics of VM26 given intrapericardially or intravenously in patients with malignant pericardial effusion.
        Cancer Chemother Pharmacol. 1987; 20: 239-242