MESOTHELIOMA TREATMENT
While no known cure for mesothelioma exists, there are treatment options available which can prolong the lifespan of mesothelioma patients. Mesothelioma treatment options include surgery, chemotherapy, radiation therapy, and immunotherapy or a combination of any of the four, which has proven to be more effective than any one individual treatment alone. The type of treatment depends on the stage of the cancer, the patient's overall health, and the type of mesothelioma. In addition, mesothelioma patients may also try experimental treatments through clinical trials.
SURGERY
The three main types of surgery for mesothelioma include:
Extrapleural Pneumonectomy (EPP)
An EPP involves the removal of the cancerous lung and parts of the lining of the chest, lining of the heart, the diaphragm and nearby lymph nodes. In general, patients diagnosed with earlier stages of mesothelioma and who are in relatively good health are considered good candidates for this surgery.
Pleurectomy/Decortication (P/D)
The Pleurectomy/Decortication surgery removes the cancer lining of the chest wall, along with any tumors growing inside the chest. This is a less extensive surgery than EPP because the lung is not removed. Like EPP, patients diagnosed with earlier stages of mesothelioma and who are in relatively good health are considered good candidates for this surgery.
Cytoredcution with HIPEC
The Cytoreductive surgery removes tumors from the abdomen, this is the only surgical option for patients with peritoneal mesothelioma. When paired with hyperthermic intraperitoneal chemotherapy (HIPEC), the surgery can increase a patient’s life expectancy. Patients diagnosed with peritoneal mesothelioma and who are in relatively good health are considered good candidates for this surgery.
CHEMOTHERAPY
Chemotherapy is an anti-cancer drug that kills fast-growing cancer cells. The following chemotherapy drugs, or a combinations of any of two of these drugs, may be prescribed to treat mesothelioma:
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Pemetrexed (Alimta®)
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Cisplatin
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Carboplatin
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Gemcitabine (Gemzar®)
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Methotrexate
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Vinorelbine
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Mitomycin
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Doxorubicin (Adriamycin®)
RADIATION
Radiation therapy may be used in all stages of cancer. It may be used following surgery to remove any remaining areas of cancer that were not seen or removed during surgery, this is referred to as adjuvant radiation therapy. Radiation therapy may be used as a palliative procedure to ease mesothelioma symptoms such as pain, shortness of breath, etc. There are only two types of radiation therapy are used to treat mesothelioma:
External beam radiation therapy (EBRT): This is the most common and effective. This radiation therapy uses x-rays from a machine outside the body to kill cancer cells.
Brachytherapy: For this kind of radiation therapy, which is rarely used for mesothelioma, a radiation source is put inside the body, in or near the cancer. Because the radiation travels only a very short distance, it minimizes any potential damage to nearby healthy tissues.
IMMUNOTHERAPY
Immunotherapy is a type of cancer treatment that occurs when a person’s own immune system is used to fight cancer cells. It is an area of research that is rapidly expanding, as researchers are continuing to explore new and innovative approaches to immunotherapy. It is also becoming an increasingly popular treatment for many types of cancer, including mesothelioma.
The most common type of immunotherapy used to treat mesothelioma cancer is called checkpoint inhibitors. These drugs block the signals that cancer cells use to suppress the body’s immune system. By blocking these signals, the immune system is better able to recognize and attack cancer cells. Another type of immunotherapy is called adoptive cell transfer. which involves taking a patient's own immune cells and genetically modifying them to recognize and attack the cancer cells. This is a more tailored approach to immunotherapy and can be used in combination with other treatments, such as surgery, chemotherapy, and radiation. This can help to target the cancer cells more effectively and reduce the risk of the cancer spreading to other parts of the body. Immunotherapy is thought to be less toxic than traditional cancer treatments and has fewer side effects. Immunotherapy has also been found to extend patients quality of life and slow the progression of the disease; however, it is still in its early stages and the research is ongoing.
The combination of immunotherapy drugs Opdivo (nivolumab) and Yervoy (ipilimumab) was recently approved as a first-line treatment for pleural mesothelioma. Clinical trials with larger populations of mesothelioma patients will provide further details on the efficacy of immunotherapy for mesothelioma and its possible side effects. Current immunotherapy drugs being studied for mesothelioma include:
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Nivolumab (Opdivo)
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Pembrolizumab (Keytruda)
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Tremelimumab`
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Atezolizumab (Tecentriq)
Patients should discuss their treatment options with their healthcare team to determine the best course of action for their specific case. To view current immunotherapy clinical trials for mesothelioma, click here.