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Treatments for Mesothelioma

More options are now available

Malignant mesothelioma is highly aggressive and resistant to many standard cancer treatments. It is difficult to treat effectively.  Although the outlook for mesothelioma victims remains grim, advances have been made in treatments that can control symptoms, increase survival time, and improve the quality of life.  In fact, according to the April 5, 2011 National Cancer Institute Bulletin, a new test may be able to detect malignant mesothelioma in its earliest stages using 13 protein markers in the blood.

Mesothelioma specialists are in the best position to assess and advise on which treatments are most likely to produce the most positive results in each case.  Treatment options are usually determined by the stage of the disease.

Conventional mesothelioma treatments

Conventional mesothelioma treatments include surgery, radiation, and chemotherapy. Using therapies together (multimodal therapies) often enhances results.

Surgery

Mesothelioma surgical options range from inserting a tube to drain fluid accumulations to radical procedures that remove as much diseased tissue as possible:

  • Extra-pleural pneumonectomy. A procedure that removes the parietal pleura, diaphragm, pericardium, and entire lung on the affected side
  • Pleurectomy decortication. Surgery similar to an extrapleural pneumonectomy, but the lung is left in place
  • Debulking pleurectomy. Removal of most of cancer from the pleura to help ease breathing
  • Decortication. Removal of pleura constricting the lung
  • Catheters and shunts. Relieves fluid build-up
  • Pleurodesis. Surgery that fuses the pleura to prevent fluid build-up

Chemotherapy

Mesothelioma chemotherapy treatment is designed to slow the growth of malignant mesothelioma cells.  Currently, Alimta (pemetrexed) therapy—which combines Alimta with cisplatin—is accepted as the standard of care in mesothelioma chemotherapy treatment.  Researchers are also investigating new chemotherapy agents. Experimental chemotherapy treatments for mesothelioma are in active clinical trials.

Radiation

Radiation treatments for mesothelioma generally are administered after surgery.  Radiation therapy required to remove all the tumors would be too damaging to the heart and other vital nearby tissues. However, lower doses are useful when targeted at the locations susceptible to further mesothelioma growth after surgery.

Experimental treatments for mesothelioma

The following non-traditional therapies for mesothelioma have shown promising results in trials:

  • Photodynamic therapy. The patient first receives a drug that collects in cancerous cells making the cells sensitive to a certain kind of light.  That light is then delivered through surgically placed fiber optic cables, producing toxic molecules that kill the cancer cells.
  • Gene therapy. A suicide gene is inserted directly into tumors, making their cells sensitive to a drug that can destroy them while leaving the healthy cells unharmed.
  • Immunotherapy. Also called biological response modifiers (BRMs), this therapy treats cancer by using the patient’s own immune system to fight cancer cells.  Although still under development, some of the mesothelioma patients with the longest survival rates reported using some method of strengthening their immune systems.

Treating Stage I mesothelioma

Treatment in stage I depends on where the mesothelioma is located.  If the mesothelioma is located in only one part of the pleural lining, surgery is probably the best treatment.  If  the mesothelioma is found in more than one place in the chest, the National Cancer Institute (NCI) lists the following treatment choices to relieve symptoms and improve the quality of life:

  • Pleurectomy and decortication, with or without radiation therapy.
  • Extra-pleural pneumonectomy.
  • Radiation therapy.
  • One of the following clinical trials:
    • Anticancer drugs placed directly into the chest after surgery to remove the tumor.
    • Combinations of surgery, radiation therapy, and chemotherapy
    • Other new treatment.

Treating Stage II, Stage III, and Stage IV mesothelioma

According to NCI, treatment of advanced malignant mesothelioma may include the following to reduce pain, relieve symptoms, reduce discomfort, and improve the quality of life:

  • Surgery to drain fluid that has collected in the chest. Pleurodesis may be done to stop more fluid from collecting in the chest.
  • Pleurectomy and decortication.
  • Radiation therapy.
  • Chemotherapy with one anticancer drug.
  • A clinical trial of combination chemotherapy.
  • A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
  • A clinical trial of chemotherapy placed directly into the chest cavity or abdominal cavity to shrink the tumors and keep fluid from building up.

Finding information about clinical trials

There are many clinical trials testing new mesothelioma treatments.  For many patients, participating in a mesothelioma clinical trial can be the best treatment option. Many of today’s mesothelioma treatments are based on previous clinical trials. In a clinical trial  a patient will receive either a standard treatment or an experimental treatment. Patients can enroll in a clinical trial any time during their treatment, depending on the trial.

Clinical trials are taking place in many parts of the country. The National Cancer Institute maintains a list of clinical trials.