Long-Term Treatment of Unresectable Pseudomyxoma Peritonei with Multiple Treatments of Intratumoural Bromelain and Acetylcysteine (BromAc <sup>®</sup>): A Case Report

Yang, Jessica; Glenn, Derek; Lodh, Suhrid; Valle, Sarah J.; Morris, David Lawson

doi:10.1159/000534202

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Long-Term Treatment of Unresectable Pseudomyxoma Peritonei with Multiple Treatments of Intratumoural Bromelain and Acetylcysteine (BromAc ^®): A Case Report

case-report

Author(s): Jessica Yang ^a ^, ^b , Derek Glenn ^c , Suhrid Lodh ^c , Sarah Valle ^a ^, ^d , David Lawson Morris ^a ^, ^b ^, ^d ^,

Publication date (Electronic): 8 December 2023

Journal: Case Reports in Oncology

Publisher: S. Karger AG

Keywords: Bromelain, Acetylcysteine, Pseudomyxoma peritonei

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Abstract

Pseudomyxoma peritonei is a rare peritoneal malignancy characterized by the progressive accumulation of mucinous material and tumour within the abdomen and pelvis. Percutaneous drainage of mucin may be a non-surgical option for relief of symptoms; however, it remains difficult due to the high viscosity of mucin, with numerous case reports reporting difficulty removing material through medium-bore catheters alone. BromAc is a therapy currently undergoing development which dissolves mucinous tumour masses and allows for extraction. This report describes the case of a patient who has had multiple treatments with BromAc over 4 years.

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Most cited references 12

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CARE 2013 Explanations and Elaborations: Reporting Guidelines for Case Reports.

David Riley, Melissa S Barber, Gunver S Kienle … (2017)

Well-written and transparent case reports (1) reveal early signals of potential benefits, harms, and information on the use of resources; (2) provide information for clinical research and clinical practice guidelines (CPGs), and (3) inform medical education. High-quality case reports are more likely when authors follow reporting guidelines. During 2011-2012 a group of clinicians, researchers, and journal editors developed recommendations for the accurate reporting of information in case reports that resulted in the CARE (CAse REport) Statement and Checklist. They were presented at the 2013 International Congress on Peer Review and Biomedical Publication, have been endorsed by multiple medical journals, and translated into nine languages. This explanation and elaboration document has the objective to increase the use and dissemination of the CARE Checklist in writing and publishing case reports. Each item from the CARE Checklist is explained and accompanied by published examples. The explanations and examples in this document are designed to support the writing of high-quality case reports by authors and their critical appraisal by editors, peer reviewers, and readers. This article and the 2013 CARE Statement and Checklist, available from the CARE website [www.care-statement.org] and the EQUATOR Network, [www.equator-network.org] are resources for improving the completeness and transparency of case reports.

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Appendiceal tumours and pseudomyxoma peritonei: Literature review with PSOGI/EURACAN Clinical Practice Guidelines for diagnosis and treatment

K. Govaerts, R.J. Lurvink, I.H.J.T. de Hingh … (2020)

Pseudomyxoma Peritonei (PMP) is a rare peritoneal malignancy, most commonly originating from a perforated epithelial tumour of the appendix. Given its rarity, randomized controlled trials on treatment strategies are lacking, nor likely to be performed in the foreseeable future. However, many questions regarding the management of appendiceal tumours, especially when accompanied by PMP, remain unanswered. This consensus statement was initiated by members of the Peritoneal Surface Oncology Group International (PSOGI) Executive Committee as part of a global advisory role in the management of uncommon peritoneal malignancies. The manuscript concerns an overview and analysis of the literature on mucinous appendiceal tumours with, or without, PMP. Recommendations are provided based on three Delphi voting rounds with GRADE-based questions amongst a panel of 80 worldwide PMP experts.

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Approach to pseudomyxoma peritonei

Syed Ali Asad Rizvi, Wajahat Syed, Ravi Shergill (2018)

Pseudomyxoma peritonei (PMP) is a mucinous tumour of the appendix that spreads into the peritoneal cavity in the form of gelatinous deposits. The incidence of PMP is believed to be approximately 1-3 out of a million per year. Nonetheless, due to its indolent nature, it is usually discovered at an advanced stage and severely impacts quality of life. Curative treatment for PMP is complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). An extensive literature review was conducted searching EMBASE, MEDLINE, PubMed, and Google Scholar databases for PMP in aims to delineate a clinical approach to diagnosis and treatment. Literature was limited to the years 2007-2018. We found the 5-year overall survival with CRS and HIPEC estimated to be between 23%-82% and rates of major complications as high as 24%. Therefore, it is important to appropriately stage and select patients that should undergo CRS with HIPEC. Modalities like MDCT radiological scores have been shown to have sensitivity and specificity of 94% and 81%, respectively, in being able to predict resectability and survival. Despite treatment, the disease often recurs. Tumor markers have significant potential for establishing prognosis pre-operatively, and this paper will review the most recent evidence in support of them.

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Author and article information

Journal

Journal ID (nlm-ta): Case Rep Oncol

Journal ID (iso-abbrev): Case Rep Oncol

Journal ID (hwp): CRO

Journal ID (publisher-id): CRO

Title: Case Reports in Oncology

Publisher: S. Karger AG (Basel, Switzerland )

ISSN (Electronic): 1662-6575

Publication date (Electronic): 8 December 2023

Publication date Collection: Jan-Dec 2023

Publication date PMC-release: 8 December 2023

Volume: 16

Issue: 1

Pages: 1551-1556

Affiliations

[a ]Department of Surgery, St George Hospital, Sydney, NSW, Australia

[b ]Department of Surgery, University of New South Wales, St George Clinical School, Sydney, NSW, Australia

[c ]Department of Radiology, St George Hospital, Sydney, NSW, Australia

[d ]Mucpharm Pty Ltd, Sydney, NSW, Australia

Author notes

Correspondence to: David Lawson Morris, david.morris@ 123456unsw.edu.au

Article

Publisher ID: 534202

DOI: 10.1159/000534202

PMC ID: 10708900

PubMed ID: 38074518

SO-VID: ec194176-1d19-488f-93c9-a90cce13ab9c

License:

This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

History

Date received : 2 November 2022

Date accepted : 5 July 2023

Date: 2023

Page count

Figures: 1, Tables: 1, References: 12, Pages: 6

Funding

There was no funding received specifically for this case report. The original phase 1 trial of BromAc which this patient was a part of was supported by Mucpharm Pty Ltd., the David Morris Cancer Research Fund (UNSW Foundation/Division of Philanthropy), and the Appendix Cancer and Pseudomyxoma Peritonei (ACPMP) Research Foundation.