Study of Cytoreductive Surgery and Hyperthermic Intraoperative Chemotherapy With Pemetrexed and Cisplatin for MPM

Inclusion Criteria:

1. Histologically proven malignant pleural mesothelioma MPM that is considered resectable according to the following criteria:

   * Confined to one pleural space
   * No chest wall invasion
   * No transdiaphragmatic involvement
   * No invasion of mediastinal structures
2. Age ≥ 18 years
3. Eastern Cooperative Oncology Group performance status 0-1 (Appendix A)
4. Adequate cardiopulmonary reserve defined as follows as assessed within 4 months of study entry:

   * Predicted postoperative forced expiratory volume FEV1 \> 1L
   * Normal left ventricular function (Ejection Fraction EF ≥ 45%) and right ventricular function
   * No pulmonary hypertension noted on preoperative transthoracic echocardiography
5. Must have adequate hematologic, renal and hepatic function as defined by the following laboratory values (completed within 60 days of surgery) Hematologic: Hemoglobin ≥ 9.0 g/dL, absolute neutrophil count (ANC) ≥ 1500/mm3, platelet count ≥ 100,000/mm Renal: Calculated creatinine clearance ≥ 60 mL/min

   The creatinine clearance CrCl is determined by the Cockcroft-Gault formula:

   Males:

   Creatinine Clearance CrCl (mL)/min) = weight (kg) x (140-age) 72 x serum creatinine (mg/dL)

   Females:

   Creatinine Clearance CrCl (mL)/min) = weight (kg) x (140-age) x 0.85 72 x serum creatinine (mg/dL)

   Hepatic: Total bilirubin \< 1.5 times the upper limit of institutional normal value; Aspartate aminotransferase AST (Serum glutamic oxaloacetic transaminase SGOT) and alanine aminotransferase ALT (Serum glutamic pyruvic transaminase SGPT) \< 3 times the upper limit of the institutional normal Coagulation: international normalized ratio INR ≤ 1.5 in patients not utilizing systemic anticoagulation as part of their medical regimen
6. Women of child bearing potential and sexually active males must use an accepted and effective non-hormonal method of contraception
7. Patients must be deemed by the investigators to be fully recovered from both acute and late effects of any prior surgery, radiotherapy, or other antineoplastic therapy
8. Voluntary written informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.
9. The ability to interrupt non-steroidal anti-inflammatory drugs NSAIDS 2 days before (5 days for long-acting NSAIDs), the day of, and 2 days following administration of Pemetrexed.
10. The ability to take folic acid, Vitamin B12, and dexamethasone according to protocol.

Exclusion Criteria:

1. Not pregnant or breastfeeding - the drugs used in this study are Pregnancy Category D (clear evidence of risk in pregnancy). A negative pregnancy test is required within 14 days of registration for pre- or perimenopausal (i.e., last menstrual period within one year of registration) women.
2. Patients with a history of another neoplasm, with the exception of non-metastatic, non-melanoma skin cancers, carcinoma in situ of the cervix, or cancer cured by surgery or small field radiotherapy, within 5 years of registration will be excluded.
3. Patients with uncontrolled cardiovascular disease (a history of hospitalization for acute myocardial infarction, arrhythmia, or congestive heart failure within 3 months prior to registration) will be excluded
4. Registered patients with an active infection or with a fever of ≥ 38.5°C within 24 hours of the first scheduled day of protocol initiation will be excluded until their infection and/or fever resolves.
5. Any other medical condition, including mental illness or substance abuse, deemed by the Investigator to be likely to interfere with a patient's ability to sign informed consent, cooperate and participate in the study, or interfere with the interpretation of the results.
6. Inability to interrupt use of non-steroidal anti-inflammatory drugs (NSAIDS)
7. Peripheral neuropathy \>/= Grade 2 (Common Terminology Criteria for Adverse Events CTCAE)
8. Systemic chemotherapy within 3 weeks of registration
9. Prior Allergies: History of allergic reactions attributed to compounds of similar chemical or biologic composition to cisplatin and pemetrexed
10. Presence of third space fluid which cannot be controlled by drainage.