Pressurized Intrathoracic Aerosol Chemotherapy
Pressurized Intrathoracic Aerosol Chemotherapy (PITAC) for Pleural Mesothelioma: Stanford's First North American Cases (2026)
Executive Summary
Pressurized intrathoracic aerosol chemotherapy (PITAC) is an investigational, minimally invasive way to deliver chemotherapy directly into the chest cavity for patients with pleural mesothelioma. During a short video-assisted thoracoscopic surgery (VATS) procedure, chemotherapy is aerosolized into a pressurized fine mist and delivered into the pleural space — described by Dr. Leah Backhus, one of the Stanford surgeons performing it, as "spray paint chemo."[1] Stanford Medicine performed the first North American PITAC procedures for mesothelioma in 2026, offered through a registry study that also tracks quality of life; Stanford itself states that more research is needed to determine PITAC's long-term effects on the lungs.[1] The supporting evidence is limited to that registry and a small European pilot series of nine patients — safety and feasibility signals, not proof of a survival or symptom benefit.[2] PITAC should not be confused with an unrelated, incorrect expansion of the same acronym sometimes seen online ("Pleural Immune-Targeted" or similar) — the correct term is pressurized intrathoracic aerosol chemotherapy, and it is distinct from the more established abdominal-cavity version of the technique, PIPAC.
Why This Matters
Many patients with pleural mesothelioma are not candidates for radical surgery, and options for delivering treatment directly to the chest lining — rather than through the bloodstream — have been limited. PITAC is an emerging attempt to bring an aerosolized, pressurized delivery approach already used in the abdomen (PIPAC) into the chest cavity instead. Stanford's first North American cases in 2026 make this a genuinely new development to understand, but the evidence supporting it is still early: a registry study and a handful of patients treated in Italy. Patients and families should understand what PITAC is, how mature the evidence actually is, and why it is not yet an established or widely available treatment.
At a Glance
PITAC for pleural mesothelioma in 2026:
- What it is — chemotherapy aerosolized into a pressurized mist and delivered into the chest cavity through minimally invasive (VATS) access.[3]
- First North American cases — Stanford Medicine performed the first PITAC procedure for mesothelioma in North America in March 2026 (Leah Backhus, MD, MPH, with Byrne Lee, MD), with a second case in May 2026.[1]
- Offered through a registry study — Stanford provides PITAC within a registry study that also tracks quality of life; Stanford states more research is needed on long-term lung effects.[1]
- Early evidence only — a European pilot study of nine patients (11 procedures) with unresectable pleural mesothelioma reported no intraoperative or postoperative complications and zero 30-day mortality.[2]
- Not proven effective — the pilot study is explicitly preliminary and exploratory, with no control group; its authors caution that a single patient's notable outcome is anecdotal and should not be over-interpreted.[2]
- Distinct from PIPAC — PITAC (chest) is adapted from PIPAC (abdomen), the more established version of this pressurized-aerosol approach used for peritoneal mesothelioma.[2]
- Single-center in North America — as of 2026, Stanford is the only U.S. center reported to have performed these procedures; PITAC is not generally available.[1]
- Investigational — PITAC is not FDA-cleared and is not a standard of care for pleural mesothelioma.
Key Facts
| Essential PITAC Information | |
|---|---|
| Full Name | Pressurized Intrathoracic Aerosol Chemotherapy (PITAC) |
| Disease | Malignant pleural mesothelioma (chest lining) |
| How It Is Given | Video-assisted thoracoscopic surgery (VATS); chemotherapy aerosolized into the chest under ~12 mmHg CO₂ pressure for a 30-minute dwell |
| Chemotherapy Regimen (pilot series) | Cisplatin 10.5 mg/m² plus doxorubicin 2.1 mg/m² |
| Contrast: PIPAC | The abdominal-cavity version of the same pressurized-aerosol approach, used for peritoneal mesothelioma |
| First North American Cases | Stanford Medicine — March 2026 and May 2026 |
| Evidence Base | Stanford registry study; European pilot series (9 patients, 11 procedures, 2022–2024) |
| Regulatory Status | Investigational — not FDA-cleared |
What Is PITAC and How Does It Work?
PITAC stands for pressurized intrathoracic aerosol chemotherapy — pressurized chemotherapy delivered as an aerosol into the chest (thoracic) cavity, not "Pleural Immune-Targeted" or any similar-sounding expansion that has circulated online. During a minimally invasive VATS procedure, surgeons insert small trocars into the chest wall, drain any existing fluid, and inflate the chest cavity with carbon dioxide to roughly 12 mmHg. A specialized nebulizer then aerosolizes chemotherapy — in the published pilot series, cisplatin and doxorubicin — into a pressurized mist that is held in the sealed chest cavity for about 30 minutes before the team re-enters and completes the procedure.[2] The Stanford team performing the procedure has described it in plain terms as "spray paint chemo," reflecting how the aerosol is intended to coat the pleural surface evenly.[1] The pressurized delivery is intended to help the drug spread more evenly across the chest lining and reach tumor deposits than a simple liquid instillation would, while also promoting pleurodesis (sealing the space to control fluid buildup).[2]
How Is PITAC Different From PIPAC?
PITAC is directly adapted from pressurized intraperitoneal aerosol chemotherapy (PIPAC), the better-established version of this technique used for peritoneal mesothelioma and other abdominal cancers.[2] Both approaches share the same basic idea — chemotherapy aerosolized under CO₂ pressure inside a closed body cavity — but they treat different spaces: PIPAC delivers the aerosol into the abdominal (peritoneal) cavity, while PITAC delivers it into the chest (pleural/thoracic) cavity. PIPAC has a longer track record, including a randomized trial (MESOTIP) and case series reporting extended use in some patients.[2] PITAC is newer, has a much smaller published evidence base, and — as of 2026 — has only recently reached North American practice at a single center. The two should not be confused with one another, and neither should be confused with HIPEC (a single heated chemotherapy bath given during open cytoreductive surgery), which is a different procedure entirely.
Stanford's First North American PITAC Procedures
In March 2026, Leah Backhus, MD, MPH, performed the first PITAC procedure for mesothelioma in North America, working jointly with Byrne Lee, MD, at Stanford Medicine; a second case followed in May 2026.[1] Stanford offers PITAC through a registry study that tracks quality of life alongside procedural outcomes, and the institution is explicit that "more studies are needed to determine its long-term effectiveness on the lungs" — meaning the long-term safety of repeatedly pressurizing and treating the chest cavity this way is not yet established.[1] As of 2026, Stanford is the only reported North American center offering the procedure; it is not a treatment a patient can simply request at any hospital, and eligibility is determined case by case.
What Does the Evidence Show for PITAC in Mesothelioma?
The published evidence base for PITAC in mesothelioma is small and early-stage. A pilot study from the University Hospital of Pisa in Italy treated nine patients with unresectable pleural mesothelioma across eleven PITAC procedures between January 2022 and December 2024, using cisplatin plus doxorubicin at 12 mmHg CO₂ pressure for a 30-minute dwell.[2] The study reported no intraoperative or postoperative complications and zero 30-day mortality, a median chest tube duration of two days, and a median hospital stay of four days — encouraging safety and feasibility signals.[2] Effective pleurodesis (control of fluid buildup) was achieved in all patients at one month, with results sustained beyond six months in seven of the nine.[2]
One patient in the pilot series drew particular attention: a 79-year-old man with a prior history of peritoneal mesothelioma who later developed pleural disease underwent two PITAC procedures roughly a year apart, and biopsies after the second procedure showed no evidence of malignancy at previously biopsied and newly sampled sites.[2] The study's own authors caution that this is a single, anecdotal case, that the study included no control or comparison group, and that the finding should not be over-interpreted as proof that PITAC treats the underlying cancer.[2] The authors explicitly describe their work as preliminary and exploratory, and state that a larger prospective phase II study is underway to evaluate pleural fluid control, overall survival, quality of life, and tolerability.[2] Combined with Stanford's own registry-only framing, the honest summary is that PITAC currently has safety and feasibility data — not proof of a survival or symptom benefit.
What Does This Mean for Patients?
For a patient with pleural mesothelioma who may not be a candidate for radical surgery, PITAC is a development worth knowing about — but it is not yet a proven, widely available treatment. It is currently offered only through a registry study at a single U.S. center (Stanford), supported by a small, uncontrolled pilot series from Italy. Reasonable questions for a mesothelioma specialist include whether a registry-based procedure like PITAC could be appropriate given your specific case, what the known and unknown risks are, and whether a clinical trial might be a better-studied alternative. Patients researching active studies can review the mesothelioma clinical trials overview, and those considering surgical options can review the latest treatment advances and pleural mesothelioma overview pages.
Because mesothelioma care is expensive regardless of which treatments a patient pursues, families are encouraged to document treatment expenses as they arise. Compensation for these costs may be available through asbestos trust funds, U.S. Department of Veterans Affairs benefits, and legal claims against the companies responsible for the asbestos exposure that caused the disease — a firm such as Danziger & De Llano can walk families through available compensation options while their medical team focuses on treatment decisions. Prior verdicts and settlements in mesothelioma cases, reviewed at Danziger & De Llano's verdicts and settlements page, can also help families understand what has been recovered in comparable cases.
This page is educational only and does not promise the availability, eligibility, or effectiveness of any treatment.
Frequently Asked Questions
What is PITAC for pleural mesothelioma?
PITAC — pressurized intrathoracic aerosol chemotherapy — is an investigational treatment that delivers chemotherapy as a pressurized aerosol into the chest cavity during minimally invasive (VATS) surgery. It is being studied for pleural mesothelioma and is not FDA-cleared or a standard of care.[3]
Is PITAC the same as PIPAC?
No, though they are closely related. PIPAC (pressurized intraperitoneal aerosol chemotherapy) treats the abdominal cavity and has a longer track record for peritoneal mesothelioma. PITAC is adapted from PIPAC but delivers the aerosol into the chest (pleural) cavity instead, and has a much smaller published evidence base.[2]
Who performed the first North American PITAC procedure?
Stanford Medicine performed the first North American PITAC procedure for mesothelioma in March 2026 (Leah Backhus, MD, MPH, with Byrne Lee, MD), with a second case in May 2026.[1]
Does PITAC cure mesothelioma or extend survival?
There is no evidence yet that PITAC cures mesothelioma or extends survival. The available data are a Stanford registry study and a small European pilot series showing the procedure is feasible and appears safe; one patient's notable biopsy outcome was described by the study's own authors as an anecdotal, single-case finding, not proof of an antitumor effect.[2][1]
Is PITAC widely available?
No. As of 2026, Stanford is the only reported North American center offering PITAC for mesothelioma, and it is provided through a registry study rather than as routine, generally available care.[1]
External Links
- Danziger & De Llano — Mesothelioma attorneys, (855) 699-5441.
- Mesothelioma Compensation Options — Danziger & De Llano.
See Also
- PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy)
- Pleural Mesothelioma
- Pleural Effusion
- Latest Treatment Advances for Mesothelioma
- Mesothelioma Clinical Trials
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Stanford Medicine, Department of Cardiothoracic Surgery. Stanford Performs First PITAC Procedure for Mesothelioma in North America. 2026.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 Mastromarino MG, Guerrini E, Guerrieri R, Elia G, Lenzini A, Aprile V, Alì G, Korasidis S, Ambrogi MC, Lucchi M. Twice as Effective? Pressurized Intra-Thoracic Aerosol Chemotherapy: New Frontiers in Pleural Mesothelioma. Medical Sciences. 2025;13(2):72. PMID 40559230.
- ↑ 3.0 3.1 Stanford Medicine, Department of Cardiothoracic Surgery. Pressurized Intrathoracic Aerosol Chemotherapy (PITAC) service page. 2026.